2013 community health needs assessment-south pointe hospital

2013 Community Health Needs Assessment-South Pointe HospitalFounded in 1957, South Pointe Hospital is an acute care community teaching hospital

with 173 staffed beds, offering advanced medical and surgical care, sophisticated

technology, research and education. The hospital has specialties in cardiology, cancer,

diabetes, gastroenterology, orthopaedics, pain management, radiology, urology and

wound care. The facility has been designated as a Primary Stroke Center by the Joint

Commission. South Pointe Hospital has been part of Cleveland Clinic since 1997.

Cleveland Clinic’s health system in Northeast Ohio consists of an academic medical cen-

ter, two children’s hospitals and eight community hospitals. Each hospital is dedicated to

supporting the communities it serves. We verify the health needs of our communities by

performing periodic community health needs assessments (CHNAs). These formal assess-

ments are analyzed using widely accepted criteria to determine and measure the health

needs of a specific community. In accordance with Internal Revenue Code Section 501(r)(3),

each hospital has conducted its own community health needs assessment.

Upon review of all of the community health needs assessments for all of our Northeast

Ohio facilities, Cleveland Clinic has identified five community health needs that are pres-

ent in the majority of hospital communities we serve. They are: Chronic Disease, Wellness,

Access to Affordable Health Care, Access to Community Services, and Economic and

Community Development.

South Pointe Hospital has identified four of these needs in its CHNA: Chronic Disease,

Access to Affordable Health Care, Access to Community Services, and Economic and

Community Development.

We are pleased to share the following CHNA report with you.

South Pointe Hospital Community Health Needs Assessment – Final Report

February 24th, 2012

Community Health Needs Assessment South Pointe Hospital Tripp Umbach

Table of Contents

�� Introduction… Page:��

��Community Definition… Page:��

��Consultant Qualifications… Page:��

��Project Mission… Page:��

��Objectives… Page:��

��Methodology… Page:��

��Key Community Health Needs… Page:�

��Secondary Data… Page:��

��Key Stakeholder Interviews… Page:��

��Focus Groups with Community Residents… Page:��

��Conclusions … Page:��

��Appendix A: Key Stakeholder Organizations… Page:��

��Appendix B: South Pointe Hospital Community Secondary Data

Profile…Page:��

��Appendix C: South Pointe Hospital Interview Summary – Key Stakeholder

Group… Page:��

��Appendix D: South Pointe Hospital Focus Group Summary – Residents Familiar with Diabetic Issues Group … Page:��

��Appendix E: South Pointe Hospital Focus Group Summary – Underinsured or Uninsured Group … Page:��

��Appendix F: South Pointe Hospital Focus Group Summary – Senior

Residents Group … Page:��

��Appendix G: Inventory of Community Resources … Page:��


Introduction

South Pointe Hospital, a 213-bed community hospital located in Warrensville Heights, OH, in response to its community commitment, contracted with Tripp Umbach to facilitate a comprehensive Community Health Needs Assessment (CHNA). The community health needs assessment was conducted between February and June 2011. South Pointe Hospital is a member of the Cleveland Clinic Health System. During the community health needs assessment process, South Pointe Hospital collaborated with other hospitals comprising the Cleveland Clinic Health System:

�� Lakewood Hospital �� Hillcrest Hospital �� Fairview Hospital �� Euclid Hospital �� Marymount Hospital �� Lutheran Hospital �� Cleveland Clinic Main Campus �� Medina Hospital �� Cleveland Clinic Children’s Hospital �� Cleveland Clinic Children's Hospital for Rehabilitation �� Cleveland Clinic Florida

This report fulfills the requirements of a new federal statute established within the Patient Protection and Affordable Care Act (PPACA) requiring that non-profit hospitals conduct community health needs assessments every three years. The community health needs assessment process undertaken by South Pointe Hospital, with project management and consultation by Tripp Umbach, included extensive input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of public health issues. Tripp Umbach worked closely with senior leadership from South Pointe Hospital, members of the hospital’s community advisory council and with a project steering committee consisting of senior leaders from the Cleveland Clinic to accomplish the assessment. This report represents one in a series of 12 community health needs assessment documents being completed by Tripp Umbach for each of the Cleveland Clinic hospitals in Northeast Ohio, as well as one Cleveland Clinic Health System-wide document in Northeast Ohio.

�


��

��

��

��

��

��

��

��

��

��

��

��

��

��

��

��

��

��

��

��

��

��

��

��

��

��

��

��

��

��

��

��

��

��

��

��

��

��

��

��!""�#$%!%

� !%!�

&�'!(��)�**#

+,�-& !#�

&�'!(��)�**#

�%*%�

�. (�#$ !'�%!�&/("*-��0"-%�(�

� -#%�

�"�(�# *�

�(0&/("*-

1!"02#3(**"1!%�-3(". ��"('&�#

��!4� ��-"5"�-"�0"

��!/("*-��#

1"-/%!-

��5*"��"('&�#

6�!!"�#3(**"��#

�". $ !'&�7�6(**%.

1"�0&. %%-�&�2"!��#

�(--*"$ !'��#

�%!�&��%,�*�%�

�� 0*(-

*"3 ��#

��!4��#

�(�02*",

South Pointe

��1"-/%!-

��!,4% ��

�(**0!"#��

��

��

��

��

��

�

��

��

��

��

��

��

��

��

��

��

��

��

��

��

��

��

��

��

��

��

��

��

��

Community Definition

While community can be defined in many ways, for the purposes of this report, the South Pointe Community is comprised of 13 zip code areas covering portions of Cuyahoga, Portage and Summit County in Northeast Ohio containing 80% of the hospital’s inpatient volumes (see Figure 1 & Table 1).

Zip Community County 44105 Union/Miles – Newburgh Heights Cuyahoga 44120 Shaker Heights Cuyahoga 44122 Beachwood Cuyahoga 44128 Warrensville Heights Cuyahoga 44137 Maple Heights Cuyahoga 44139 Solon Cuyahoga 44146 Bedford Cuyahoga 44202 Aurora Portage 44241 Streetsboro Portage 44056 Macedonia Summit 44067 Northfield Summit 44087 Twinsburg Summit 44236 Hudson Summit

South Pointe Hospital Community Zip Codes Table 1

South Pointe Hospital Community Map

Figure 1

�


Consultant Qualifications

The Cleveland Clinic contracted with Tripp Umbach, a private healthcare consulting firm headquartered in Pittsburgh, Pennsylvania to complete the community health needs assessment. Tripp Umbach is a recognized national leader in completing community health needs assessments, having conducted more than 200 community health needs assessments over the past 20 years. Today, more than one in five Americans lives in a community where Tripp Umbach has completed a community health assessment.

Paul Umbach, founder and president of Tripp Umbach, is among the most experienced community health planners in the United States, having directed projects in every state and internationally. Tripp Umbach has written two national guide books[1] on the topic of community health and has presented at more than 50 state and national community health conferences.

[1] A Guide for Assessing and Improving Health Status Apple Book: http://www.haponline.org/downloads/HAP_A_Guide_for_Assessing_and_Improving_Health_Status_Apple_Book_1993.pdf and

A Guide for Implementing Community Health Improvement Programs: http://www.haponline.org/downloads/HAP_A_Guide_for_Implementing_Community_Health_Improvement_Programs_Apple_2_Book_1997.pdf

�


Project Mission

The mission of the South Pointe Hospital CHNA is to understand and plan for the current and future health needs of residents in its community. The goal of the process is to identify the health needs of the communities served by the hospital while developing a deeper understanding of community needs and identifying community health priorities. Important to the success of the community needs assessment process is meaningful engagement and input from a broad cross-section of community-based organizations, who were partners in the community health needs assessment.

�


Objectives

The objective of this assessment is to gather traditional health-related indicators, as well as social, demographic, economic and environmental factors. The overall objective of the CHNA is summarized by the following areas:

�� Obtaining information on population health status, as well as socio-economic and environmental factors,

�� Assuring that community members, including underrepresented residents, were included in the needs assessment process,

�� Identifying key community health needs within the hospital’s community, along with

an inventory of available resources within the community that may provide programs and services to meet such needs, and

�� Developing a CHNA document as required by the Patient Protection and Affordable

Care Act (PPACA).

�


Methodology

Tripp Umbach facilitated and managed a comprehensive community health needs assessment on behalf of South Pointe Hospital — resulting in the identification and prioritization of community health needs. The assessment process included input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge and expertise of public health issues.

Key data sources in the community health needs assessment included:

�� Community Health Assessment Planning: A series of meetings were facilitated by the consultants and CHNA project team consisting of leadership from the Cleveland Clinic Health System and South Pointe Hospital.

�� Secondary Data: The health of a community is largely related to the characteristics of its residents. An individual's age, race, gender, education and ethnicity often directly or indirectly impact health status and access to care. Tripp Umbach completed comprehensive analysis of health status and socio-economic environmental factors related to the health of residents of the South Pointe Hospital community from existing data sources such as state and county public health agencies, the Centers for Disease Control and Prevention, Healthy People 2020 and other additional data sources.

�� Interviews with Key Community Stakeholders: Tripp Umbach worked closely with

hospital leadership to identify leaders from organizations that have special knowledge and or expertise in public health. Such persons were interviewed as part of the needs assessment planning process. A series of 11 interviews were completed with key stakeholders in the South Pointe Hospital community. Organizations represented are included in Appendix A.

�� Focus Groups with Community Residents: Tripp Umbach worked closely with hospital leadership to assure that community members, including underrepresented residents were included in the needs assessment planning process via a series of three focus groups conducted by Tripp Umbach in the South Pointe Hospital community. Focus group audiences were defined by hospital leadership utilizing secondary data to identify health needs and deficits in targeted populations. Focus group audiences included: Residents Familiar with Diabetic Issues, Underinsured or Uninsured Representatives and Senior Residents.

�


�� Identification of top community health needs: Top community health needs were identified by analyzing secondary data, key stakeholder interviews and focus group input. The analysis process identified the health needs revealed in each data source. Tripp Umbach followed a process where the top needs identified in the assessment were supported by secondary data, when available, and strong consensus provided by both key community stakeholders and focus group participants.

�� Inventory of Community Resources: Tripp Umbach completed an inventory of community resources available in the South Pointe Hospital community using resources identified by the Cleveland Clinic, internet research and United Way’s 211 First Call for Help community resource database. Using the zip codes which define the South Pointe Hospital community (40105, 44120, 44122, 44128, 44137, 44139, 44146, 44202, 44241, 44056, 44067, 44087, and 44236) more than 85 community resources were identified with the capacity to meet the three community health needs identified in the South Pointe Hospital CHNA.

�� Final Community Health Needs Assessment Report: A final report was developed

that summarizes key findings from the assessment process and an identification of top community health needs. In addition to this report prepared for South Pointe Hospital, a system-wide report is being developed for the Cleveland Clinic Health System. �


Key Community Health Needs

Tripp Umbach’s independent review of existing data, in-depth interviews with community stakeholders representing a cross-section of agencies, and detailed input provided by three community focus groups resulted in three key community health needs in the South Pointe Hospital community that are supported by secondary and or primary data. The needs identified include: 1) Adequate awareness among residents about how to access community services, 2) Adequate community infrastructure, and 3) Access to affordable healthcare (not listed in any specific order). Lack of awareness of services is a major driver of low utilization of programs and services. A summary of the top three needs in the South Pointe Hospital community follows:

��ADEQUATE COMMUNITY AWARENESS AND COHESIVENESS

Underlying factors identified by primary input from community stakeholders and focus groups with residents: Need for awareness among residents about how to access community services. �� The absence of collaboration at all levels in the South Pointe Hospital community

has caused a lack of outreach efforts and awareness about available programs and services as well as ineffective dissemination of information. Community stakeholders feel there is a lack of awareness among residents about how to access community services. Often when residents are unaware of available services, the result is a lack of participation in those services, an underserved population and unmet needs.

�� Community stakeholders identified “residents and businesses functioning cohesively” as significant to the definition of a healthy community.

�� Community focus group participants felt many residents are unaware of available resources, events, programs and services in the community due to a lack of advertisement and outreach. Participants felt residents’ access to prevention and outreach programs is limited due to a lack of funding, a lack of insurance, insurance restrictions, and a lack of programming offered by hospitals and community-based organizations (i.e., community health fairs).

�� Community focus group participants also felt the dissemination of information is

ineffective in their communities due to a high volume of disorganized, duplicated and irrelevant information being received, as well as a lack of information sharing among residents in the community. Additionally, they felt that some


residents do not have access to the information outlets that are used throughout the community, such as cable channels and the internet.

��ADEQUATE INFRASTRUCTURE

Underlying factors identified by secondary data and primary input from community stakeholders and focus groups with residents: Need for adequate community infrastructure.

�� The communities South Pointe Hospital serves have experienced funding cuts

locally due to state budget decreases. Community stakeholders and focus group participants are concerned with the stability of the infrastructure in their communities due to the decrease in resources. The impact of recent funding cuts include closing of community-based organizations, elimination of services and reduction in the number of clients that can be served, ultimately causing an overall reduction in community services that are available to meet the needs of residents resulting in unmet needs.

�� The South Pointe Hospital community is a contrast of “higher need” and “lower need” areas. The northern zip code areas of the community generally have a greater number of socio-economic barriers impacting community health compared to the southern zip code areas. The northern zip code areas of the community generally record higher CNI scores compared to the south.1

�� The unemployment rate is highest within the Union/Miles – Newburgh Heights area (44105) – over 16%.

�� In contrast, Twinsburg (44087) and Solon (44139) have unemployment rates below 4%. Solon (44139) has an uninsured rate of 4.2%.

�� Union/Miles – Newburgh Heights (44105), Shaker Heights (44120), and Bedford (44146) are specific higher need communities.

�� Union/Miles – Newburgh Heights (44105) has the highest rate of uninsured citizens (25.1%) and citizens with no high school diploma (26.1%).

�� More than 50% of single family households in Union/Miles – Newburgh Heights record annual incomes below poverty levels.

1 CNI quantifies five socio-economic barriers to community health utilizing a 5-point index scale where 5 indicate the greatest need and 1 indicates the lowest need. The five prominent socio-economic barriers to community health quantified in CNI include: Income, Culture/Language, Education, Insurance and Housing.

�


�� More than 45% of the occupied homes in Shaker Heights (44120) are renter-occupied.

�� Community stakeholders indicated some of their communities have poor

infrastructures. Specifically, stakeholders expressed concern about limited housing, the poor conditions of roads and sidewalks, and a lack of parks and recreation centers resulting in displaced citizens, reduced property values and a decrease in community cohesiveness. An increase in citizens age 65 and older has strained resources throughout the areas served by South Pointe Hospital. Older citizens utilize a disproportionate amount of community resources due to the inability to be fully self-sufficient. An aging population in the communities South Pointe Hospital serves requires additional community resources to meet the needs of an at-risk population. Some of these needs include transportation and general homeowner maintenance that is necessary to ensure public safety. More than 25% of the population 65 and older in Union/Miles – Newburgh Heights (44105), Shaker Heights (44120), and Bedford (44146) record annual incomes below poverty level.

�� Community stakeholders perceive a lack of prevention education and an absence

of healthy food options in their communities due to the absence of grocery stores, prevalence of fast food restaurants and lack of health education and outreach efforts. Access to healthy food was identified by community stakeholders as significant to the definition of a healthy community.

�� All three community focus groups identified the need for adequate community

services. Specifically, focus group participants perceive a lack of adequate community services due to funding cuts in the areas of transportation and services for underinsured/uninsured individuals causing a decrease in mobility and financial resources. Overall, the absence of convenient transportation limits the mobility of a community, limiting access to healthy food options, decreasing resident productivity and increasing health risks. Limited access to public transportation also decreases participation in community services, events, programs and health services.

�� Community stakeholders and focus group participants agreed that the lack of

adequate community infrastructure is causing a decrease in financial resources. Specifically, the impact of a weak economy on the communities South Pointe Hospital serves has caused an increase in unemployment due to a lack of sustainable jobs. Job loss coupled with a higher cost of living has resulted in an

��


overall decrease in the socio-economic status of many residents; making it difficult to afford higher local, state and federal taxes.

�� ACCESS TO AFFORDABLE HEALTHCARE AND ADEQUATE MEDICAL SERVICE PROVISION Underlying factors identified by secondary data and primary input from community stakeholders and focus groups with residents: High cost of healthcare and ineffective dissemination of information:

�� Community stakeholder interview findings support secondary data that access to

primary and preventive healthcare services is an important community health priority. Specifically, stakeholders mentioned the following elements relating to residents’ access to healthcare that a healthy community should have:

�� Access to quality healthcare �� Adequate healthcare �� Ability to identify thresholds for disease �� Hospital services �� Good preventive primary care �� Accessible primary care facilities

�� Community focus group participants identified the lack of adequate community

services for underinsured/uninsured individuals. Participants believe there is an absence of affordable uninsured health services (i.e., dental and primary, preventive and emergency medical), and cumbersome eligibility requirements for subsidized services. The lack of access to affordable uninsured health services coupled with the increased use of those services by underinsured/uninsured residents causes increased costs for hospitals.

�� Community focus group participants expressed problems in communicating with medical staff and a lack of access to medical doctors. Select participants suggested they do not receive adequate information about their health status during medical appointments. The inability to secure a same-day medical appointment, being referred to the emergency room instead of seeing a doctor, seeing a resident and/or a qualified nurse instead of a doctor and seeing a different doctor each visit has caused participants to feel uninformed about their medical treatment. A select number of focus group participants suggested specialists and surgeons in the medical community offer little to no communication. These factors contribute to participants feeling uninformed.

��


�� The increased prevalence of specific chronic diseases in the South Pointe Hospital community indicates diseases that could be prevented through increased availability of preventive education and primary care. Hypertension prevalence in the South Pointe Hospital community (333 cases per 1,000 pop.) is much higher than Ohio (286). Diabetes, strokes and weak/failing kidneys are also more prevalent in the South Pointe Hospital community than the service counties and Ohio.

�� The high PQI2 scores for low birth-weight and congestive heart failure suggest

increased education regarding preventive care has the potential to decrease the prevalence of avoidable hospitalizations and improve overall community health.

2 The Prevention Quality Indicators index (PQI) was developed by the Agency for Healthcare Research and Quality (AHRQ). The AHRQ model was applied to quantify the PQI within the Cleveland Clinic market and Ohio. The PQI index identifies potentially avoidable hospitalizations for the benefit of targeting priorities and overall community health.

��


Secondary Data

Tripp Umbach worked collaboratively with the Cleveland Clinic to develop a secondary data process focused on three phases: collection, analysis and evaluation. Tripp Umbach obtained information on the health status and socio-economic and environmental factors related to health and needs of residents of multi-community service areas comprising each of the Cleveland Clinic Hospitals. Example data sources included the Behavioral Risk Factor Surveillance System (BRFSS), Healthy People 2020 and other existing state and regional data sources. The process developed accurate comparisons to the state baseline of health measures utilizing the most current validated data. In addition to disease prevalence and health behavior data, specific attention was focused on the development of two key community health index factors; Community Need Index (CNI) and Prevention Quality Indicators Index (PQI).

Community Need Index (CNI)

In 2005 Catholic Healthcare West, in partnership with Thomson Reuters, pioneered the nation’s first standardized Community Need Index (CNI)3. CNI was applied to quantify the severity of health disparity for every zip code in Ohio based on specific barriers to healthcare access. Because the CNI considers multiple factors that are known to limit healthcare access, the tool may be more accurate and useful than existing assessment methods in identifying and addressing the disproportionate unmet health-related needs of neighborhoods.

The five prominent socio-economic barriers to community health quantified in CNI include: Income, Insurance, Education, Culture/Language and Housing. CNI quantifies the five socio-economic barriers to community health utilizing a 5-point index scale where a score of 5 indicates the greatest need and 1, the lowest need.

The CNI zip code summary provides the community hospital with valuable background information to begin addressing the community needs. Union/Miles – Newburgh Heights (44105) records the highest CNI score (greatest need) within the South Pointe community. A closer look at the Union/Miles – Newburgh Heights (44105) area reveals the highest unemployment and uninsured rates, highest percentage of individuals without a high school diploma and highest rates of families living in poverty within the South Pointe Hospital community. The CNI provides greater ability to diagnose community need as it explores areas with significant barriers to healthcare access. The overall unemployment rate for the South Pointe Hospital community is 8.1%; below the national unemployment rate currently fluctuating around 9%. The unemployment rate for Union/Miles – Newburgh Heights (44105) is 16.7%, more than double the South Pointe Hospital community, state and national levels.

3 “Community Need Index.” Catholic Healthcare West Home. Web. 16 May 2011. <http://www.chwhealth.org/Who_We_Are/Community_Health/STGSS044508>.

��


Zip Community Name County Income Rank

Insurance Rank

Education Rank

Cultural Rank

Housing Rank

CNI Score

44105 Union/Miles – Newburgh Heights Cuyahoga 5 5 4 5 5 4.8

44120 Shaker Heights Cuyahoga 4 4 2 5 5 4.0

44128 Warrensville Heights Cuyahoga 3 4 3 5 5 4.0

44146 Bedford Cuyahoga 3 3 2 5 5 3.6 44122 Beachwood Cuyahoga 2 2 1 5 4 2.8 44137 Maple Heights Cuyahoga 2 3 2 5 2 2.8 44241 Streetsboro Portage 1 2 1 2 4 2.0 44087 Twinsburg Summit 1 2 1 2 3 1.8 44139 Solon Cuyahoga 1 1 1 3 1 1.4 44202 Aurora Portage 1 1 1 2 2 1.4 44236 Hudson Summit 2 1 1 2 1 1.4 44056 Macedonia Summit 1 1 1 2 1 1.2 44067 Northfield Summit 1 2 1 1 1 1.2 South Pointe Hospital Community Summary 3 3 2 5 4 3.4

The South Pointe Hospital community is a contrast of “higher need” and “lower need” areas. The northern zip code areas of the community generally have a greater number of socio-economic barriers impacting community health compared to the southern zip code areas. The unemployment rate is highest within the Union/Miles – Newburgh Heights area (44105), over 16%. In contrast, Twinsburg (44087) and Solon (44139) have unemployment rates below 4%. Solon (44139) has an uninsured rate of 4.2%.

Union/Miles – Newburgh Heights (44105), Shaker Heights (44120), Warrensville Heights (44128) and Bedford (44146) are specific higher need communities.

�� Union/Miles – Newburgh Heights (44105) has the highest rates of uninsured citizens (25.1%) and citizens with no high school diploma (26.1%).

�� More than 50% of single-family households in Union/Miles – Newburgh Heights record annual incomes below poverty level.

�� More than 45% of the homes in Shaker Heights (44120) are renter-occupied.

Table 2 2 Source: Data from Thomson Reuters – Index prepared for Tripp Umbach

��


Prevention Quality Indicators Index (PQI)

The Prevention Quality Indicators index (PQI) was developed by the Agency for Healthcare Research and Quality (AHRQ). The AHRQ model was applied to quantify the PQI within the Cleveland Clinic market and Ohio. The PQI index identifies potentially avoidable hospitalizations for the benefit of targeting priorities and overall community health.

The quality indicator rates are derived from inpatient discharges by zip code using ICD diagnosis and procedure codes. There are 14 quality indicators. Lower index scores represent fewer admissions for each of the PQIs.

�� PQI scores in the South Pointe Hospital community are at or above Ohio for most factors. Table 3 illustrates the only areas in which the South Pointe Hospital community has higher rates.

�� The Low Birth-Weight PQI is four times higher in the South Pointe Hospital community than Ohio. Additional PQI scores higher in the South Pointe Hospital community compared to Ohio include congestive heart failure; adult asthma and urinary tract infection (see Table 3).

Prevention Quality Indicators (PQI) South Pointe Service Area Ohio Difference

Low Birth-Weight 5.36 1.21 +4.15

Congestive Heart Failure 6.94 4.66 +2.28

Adult Asthma Admission 3.63 1.99 +1.64 Urinary Tract Infection 3.81 2.66 +1.15

Table 3 Source: Ohio Hospital Association Data – Calculations by Tripp Umbach

��


Disease Prevalence, Health Behaviors & Penetrating Trauma

Data for disease prevalence and health behaviors were obtained from the 2010 Behavioral Risk Factor Surveillance System. The Behavioral Risk Factor Surveillance System (BRFSS) is a state-based system of health surveys that collects information on health risk behaviors, preventive health practices and healthcare access primarily related to chronic disease and injury. BRFSS data were provided by Thomson Reuters.

�� Hypertension prevalence in the South Pointe Hospital community (333 cases per 1,000 pop.) is much higher than any of the service counties (highest at 316) or Ohio (286).

�� Diabetes, strokes and weak/failing kidneys are more prevalent in the South Pointe Hospital community than the service counties and Ohio.

�� The South Pointe Hospital community shows lower rates of obesity, smoking,

and depression as compared to service counties and Ohio. The smoking rate for the South Pointe Hospital communities (241 per 1,000 pop.) is substantially lower than all local counties and Ohio (269).

�� However, the South Pointe Hospital community shows higher rates of high blood pressure (289 per 1,000 pop.) compared to Ohio (274).

Tripp Umbach collected statistical data from the Ohio Trauma Registry, also known as OTR, a Division of Emergency Medical Services within the Ohio Department of Public Safety. The data refers to all trauma cases resulting in severe injury occurring in Ohio during 2010. OTR trauma data provides the ability to quantify the overall frequency of trauma cases by occurrence type. There are five types of trauma quantified by OTR, asphyxia, blunt, burns, penetrating and “other”. The consultants identified the percentage of penetrating traumas compared to the overall number of trauma cases in a zip code defined hospital community. Trauma incidence is based on residence zip code, not the location of treatment. The resulting percentage provides a secondary data source quantifying the number of violent traumas related to a foreign object or shattered bone.

�� The South Pointe Hospital community has a penetrating trauma rate of 9.7%. The penetrating trauma rate for people residing in the South Pointe Hospital community is higher than the three service counties (Cuyahoga County was the highest of the three service counties at 8.7% and Ohio (6.7%).

Additional data and greater detail related to the secondary data analysis of the South Pointe Hospital Community is available in Appendix B.

��


Demographic Profile

Demographic Profile – Key Findings:

�� Hospital community is defined as a zip code geographic area based on 80% of the hospital’s inpatient volumes. The South Pointe Community is comprised of 13 zip code areas covering portions of Cuyahoga, Portage and Summit Counties in Northeast Ohio.

�� Gender, Age, Percentages of Families living in poverty and Insurance spread within the South Pointe Hospital community are consistent with service counties and Ohio.

�� The South Pointe Hospital community has a slightly higher percentage of African American citizens and citizens with a Bachelor’s degree and above as compared to the service counties and Ohio.

�� Average and median household income levels are slightly higher for citizens in the South Pointe Hospital community as compared to the service counties and Ohio.

�� The South Pointe Hospital community unemployment rate (8.1%) is slightly higher than the overall Ohio rate (7%) and less than the national rate (approximately 9%).

��

��

��

��

��

��

��

��

��

��

��

��

��

��

��

��

��

��

��

��

��

��

��

��

��

��

��

��

��

��

��

��

��

��

��

��

��

��

��

��!""�#$%!%

� !%!�

&�'!(��)�**#

+,�-& !#�

&�'!(��)�**#

�%*%�

�. (�#$ !'�%!�&/("*-��0"-%�(�

� -#%�

�"�(�# *�

�(0&/("*-

1!"02#3(**"1!%�-3(". ��"('&�#

��!4� ��-"5"�-"�0"

��!/("*-��#

1"-/%!-

��5*"��"('&�#

6�!!"�#3(**"��#

�". $ !'&�7�6(**%.

1"�0&. %%-�&�2"!��#

�(--*"$ !'��#

�%!�&��%,�*�%�

�� 0*(-

*"3 ��#

��!4��#

�(�02*",

South Pointe

��1"-/%!-

��!,4% ��

�(**0!"#��

��

��

��

��

��

�

��

��

��

��

��

��

��

��

��

��

��

��

��

��

��

��

��

��

��

��

��

��

��

South Pointe Hospital Community Geographic Definition

Figure 2

�


Key Stakeholder Interviews

Tripp Umbach worked collaboratively with the South Pointe Hospital executive leadership project team to develop a comprehensive list of community stakeholders. Stakeholders were selected based on their involvement within the community and their participation in overall community health. The following qualitative data were gathered during individual interviews with 11 stakeholders of the South Pointe area. Each interview was conducted by a Tripp Umbach consultant and lasted approximately 60 minutes. All respondents were asked the same set of questions developed by Tripp Umbach and reviewed by the South Pointe Hospital executive leadership project team (see Appendix C). The 11 stakeholders identified the following problems and/or barriers as preventing the residents of the South Pointe area from achieving their vision of a healthy community. A high level summary of community health issues identified by community stakeholders include:

�� LACK OF RESIDENT PARTICIPATION �� Stakeholders suggested residents generally avoid participation in activities

promoting community and public school system improvement. It is difficult for families with young children to maintain and promote healthy lifestyles for their children. Lack of active resident participation may also be a result of limited awareness, time, commitment and resources. Stakeholders felt there is a high prevalence of single-parent households in their communities. Often single parents who do not have support from their own families or the community become isolated and lack the time, energy and resources to be a role model for healthy behaviors and/or be heavily involved in meeting their child(ren)’s needs. A lack of involvement and role modeling from parents and community members in the lives of children often results in unhealthy behavior (e.g., exercise and eating habits), delinquency, unidentified needs, miscommunication and an overall negative impact on child physical and mental health, crime and educational performance and attainment. Stakeholders also felt there was a lack of awareness among residents about how to access community services. Often when residents are unaware of available services the result is a lack of participation in those services, an underserved population and unmet needs.

�� FINANCIAL RESOURCES ARE SCARCE �� Ohio is one of 46 states and the District of Columbia that have had to cut their state

budget since 2008. Similar to many communities in Ohio, the communities South

�


Pointe Hospital serves have felt the decrease in state budget through funding cuts locally which has required communities to raise taxes. A tax increase has allowed communities to continue providing services, but has also increased the cost of living for residents. Additionally, the impact of a weak American economy on the communities South Pointe Hospital serves has caused an increase in unemployment due to a lack of sustainable jobs. Job loss coupled with a higher cost of living has resulted in an overall decrease in the socio-economic status of many residents; making it difficult to afford higher local, state and federal taxes. Often when residents find it is unaffordable to live in an area, they must move to a more affordable community. An out-migration of residents ultimately causes a reduction in population and a further reduction in local revenue, resources and available services.

�� MEETING THE NEEDS OF AN AGING POPULATION �� An increase in citizens age 65 and older due to an aging Baby Boom generation

coupled with an increase in life expectancy has strained resources throughout America including the areas served by South Pointe Hospital. Older citizens utilize a disproportionate amount of community resources due to the inability to be self-sufficient. An aging population in the communities South Pointe Hospital serves requires additional community resources to meet the needs of an at-risk population. Some of these needs include transportation and general homeowner maintenance (i.e., mowing and snow removal) that is necessary to ensure public safety. If these needs cannot be met, the result is often higher risk of accident-related injuries, an increase in the presence of common pests (i.e., insects and rodents) and a decrease in the aesthetic value of neighborhoods.

�� LACK OF ACCESS TO AND EDUCATION ABOUT HEALTHY OPTIONS

�� Due to the role environment and behavior play in the cause and exasperation of chronic diseases (i.e., cancer, diabetes and heart disease) prevention education can be an effective method in their treatment and prevention. Stakeholders perceive a lack of prevention education and an absence of healthy options in their communities due to the absence of healthy grocery stores, prevalence of fast food restaurants and lack of health education and outreach efforts. Often when prevention services are lacking in a community residents are at greater risk of injury and poor physical and mental health due to a lack of awareness about effective preventive methods. Additionally, communities that have little or no access to healthy food options often have residents with poorer health than those with access to healthy food options.

��


The lack of access to and education about healthy options causes residents to have poorer health and require the use of health services more often.

�� POOR INFRASTRUCTURE

�� Stakeholders indicated some of their communities have poor infrastructures. Specifically, stakeholders expressed concerns about limited housing, the poor condition of roads and sidewalks, and a lack of parks and recreation centers resulting in displaced citizens, reduced property values, a decrease in community cohesiveness and an increased risk of injury, damage to personal property, and poor physical and mental health. Since the real estate bubble burst in 2006 home ownership has decreased, real estate prices have plummeted, development has halted and the cost of rent and rate of foreclosure has increased across the nation. Most communities, including those served by South Pointe Hospital, have been negatively impacted by the current real estate climate. The real estate crisis has caused displaced citizens, an increase in homelessness, multiple generation households and renters, as well as a decrease in home ownership negatively impacting property values and community cohesiveness. For these reasons, stakeholders identified limited housing as a concern in their communities. Stakeholders also felt the condition of the sidewalks and roads in some of their communities was poor and not adequate to meet the needs of the current population. Often when sidewalks and roads are poorly maintained, they pose a risk of vehicle damage and physical injury to residents. When investment in infrastructure does not keep pace with population growth, the result is heavier traffic and a consequential increase in commuter delays. Poor sidewalk and road conditions can result in an increase in residents’ dissatisfaction, vehicle maintenance costs and the need for medical services including emergency services. Additionally, stakeholders felt there was a lack of available parks and recreation centers for residents to use. The absence of available parks and recreation centers may cause a reduction in residents’ participation in outdoor activities and physical exercise, both of which have been proven to improve physical and mental functioning. The absence of physical exercise and limited sun exposure has been proven to have a negative impact on physical and mental health resulting in an increase in the need for medical and mental health services.

��


�� RESIDENTS DO NOT FEEL SAFE

�� Stakeholders indicated they suspect a number of residents do not feel safe in their communities due to an inflated perception of present crime rates. Stakeholders felt the crime rate is much lower than residents perceive it to be. However, if residents feel a community is unsafe, they are more likely to move to a community they perceive to offer more safety, causing an out-migration of residents that have access to resources (i.e., residents with large amounts of disposable income and/or good enough credit to secure home loans). A perceived lack of safety could ultimately cause a reduction in population and a further reduction in local revenue, resources and available services.

�� POOR EDUCATIONAL OUTCOMES WITHIN THE PUBLIC SCHOOL SYSTEM �� Stakeholders felt the public school system has been challenged over recent years

resulting in poor educational outcomes for children of their community. A lack of quality education results in poor academic performance and attainment, ultimately impacting future employment opportunities and earnings. Additionally, residents with school-aged children may choose to move to another community in search of higher quality educational institutions. Insufficient educational options in a community could mean a long-term decline in the local economy due to poor educational attainment, lower earning potential and an out-migration of residents.

Barriers to a healthy community were addressed during the interview, as respondents were encouraged to describe a healthy community. There were six themes identified upon review of the stakeholders’ collective definitions of a healthy community. These were: Access to Healthy Food, Access to Healthcare, Recreational Opportunities, Physically and Mentally Healthy Residents, A Strong Economy and Educational Opportunities.

�� ACCESS TO HEALTHY FOOD was identified by six stakeholders as significant to the definition of a healthy community. Specifically, stakeholders mentioned the following elements relating to access to healthy food that a healthy community should have:

�� Quality healthy food that is readily available to its residents �� Access to fresh foods �� Grocery stores �� Gardening throughout the community

��


�� ACCESS TO HEALTHCARE was identified by five stakeholders as significant to the definition of a healthy community. Specifically, stakeholders mentioned the following elements relating to access to healthcare that a healthy community should have:

�� Access to quality healthcare �� Adequate healthcare �� Ability to identify thresholds for disease �� Hospital services �� Good preventive primary care �� Accessible primary care facilities �� Available and flexible office appointments �� Continuing care �� Confidence in the community hospital

�� RECREATIONAL OPPORTUNITIES were identified by five stakeholders as significant to

the definition of a healthy community. Specifically, stakeholders mentioned the following elements relating to recreational opportunities that a healthy community should have:

�� Recreational facilities �� Recreational activities for the residents �� Access to parks and areas to walk, run and exercise �� Encourage the community to be active and engage in healthy lifestyles

�� PHYSICALLY AND MENTALLY HEALTHY RESIDENTS were identified by four stakeholders

as significant to the definition of a healthy community. Specifically, stakeholders mentioned the following elements relating to physically and mentally healthy residents that a healthy community should have:

�� A positive outlook on both physical health and mental health �� Access to exercise programs �� The ability to feed both body and mind �� Ability to be strong physically

�� A STRONG ECONOMY was identified by three stakeholders as significant to the

definition of a healthy community. Specifically, stakeholders mentioned the following elements relating to a strong economy that a healthy community should have:

�� Access to job opportunities �� Residents and businesses functioning cohesively �� Enough residents for businesses and vice versa �� Support that allows a resident to be productive �� Strong business �� Opportunities for the community

��


�� EDUCATIONAL OPPORTUNITIES were identified by three stakeholders as significant to the definition of a healthy community. Specifically, stakeholders mentioned the following elements relating to educational opportunities that a healthy community should have:

�� Competitive schools on a regional and national level �� A strong commitment to neighborhood schools �� Ability to be strong educationally

Additional data and greater detail related to the South Pointe Hospital Community Key Stakeholder Interviews is available in Appendix C.

��


Focus Groups with Community Residents

Tripp Umbach facilitated three focus groups with residents in the South Pointe Hospital community service area. Top community concerns include; absence of collaboration, inadequate community services, and difficulties experienced when seeking medical services. More than 40 residents from the South Pointe Hospital community participated in the focus groups each providing direct input related to top community health needs of themselves, their families and communities. The goal of the focus group process is that each participant feels comfortable and speaks openly so that they contribute to the discussion. It was explained to participants that there are no wrong answers, just different experiences and points of view. This process ensures that each participant shares their experiences from their point of view, even if it is different from what others have said.

Specifically, focus group participants were asked to identify and discuss what they perceived to be the top health issues and/or concerns in their communities. The focus group process gathers valuable qualitative and anecdotal data regarding the broad health interests of the communities served by the medical facilities within the service area of South Pointe Hospital. Focus group input is subject to the limitations of the identified target populations (i.e., vocabulary, perspective, knowledge, etc.) and therefore is not factual and inherently subjective in nature. What follows is a collective summary of the substantial issues and concerns that were discussed by at least two of the three focus group audiences.

The three focus group audiences were: �� Residents That are Familiar with Diabetic Issues

�� Conducted at the Southeast YMCA (Bedford, OH) �� Underinsured or Uninsured Residents

�� Conducted at the Harvard Community Center (Warrensville Heights, OH) �� Senior Residents

�� Conducted at the Bedford Heights Community Center (Bedford, OH)

Key high-level themes from focus groups include:

�� ABSENCE OF COLLABORATION AT ALL LEVELS The absence of collaboration at all levels in the community has caused a lack of outreach efforts and awareness about available programs and services, as well as ineffective dissemination of information leading residents to be confused, misinformed, unaware and underserved.

�� Lack of awareness: Group participants felt many residents are unaware of available resources, events, programs and services in the community due to a lack of advertisement and outreach. Residents’ lack of

��


awareness has caused a lack of participation and confusion resulting in an underserved population with unmet needs.

�� Limited access to prevention and outreach programs: Participants felt residents’ access to prevention and outreach programs is limited due to a lack of funding, a lack of insurance, insurance restrictions, and a lack of programming offered by hospitals and community-based organizations (i.e., community health fairs). The limited access to prevention and outreach programs causes residents to be misinformed and unaware about healthy behaviors that could reduce their risk for variety of health issues such as chronic disease, accident-related injury and poor mental health resulting in a poor health status and the need to access health services more frequently.

�� Ineffective dissemination of information: Participants indicated that the dissemination of information is ineffective in their communities due to a high volume of disorganized, duplicated and irrelevant information being received, as well as a lack of information sharing among groups in the community. Additionally, some residents do not have access to the information outlets that are used throughout the community such as cable channels and the internet. The lack of access to information causes residents to be unaware, misinformed and confused resulting in the absence of participation in and disuse of available resources, events, programs and services.

�� INADEQUATE COMMUNITY SERVICES Focus group participants perceive a lack of adequate community services due to funding cuts in the areas of transportation and services for underinsured/uninsured individuals causing a decrease in mobility, financial resources, physical health and mental health.

�� Transportation: Transportation is not always readily accessible or convenient due to the elimination of the circular bus services, cumbersome requirements of CRT and PERA services, reduction in RTA bus routes and additional travel time required. Overall, the absence of readily accessible convenient transportation causes a lack of healthy food options, limited mobility, an increase in health risks and a decrease in productivity, financial resources and participation in available events, programs and services including health services.

��


�� Services for the underinsured/uninsured: Health services are often

inaccessible to uninsured/underinsured residents due to a lack of financial resources, the absence of affordable uninsured health services (i.e., dental and primary, preventive and emergency medical), and cumbersome eligibility requirements for subsidized services. Uninsured and underinsured populations tend to be unhealthier overall than insured populations requiring more frequent use of health services. The lack of access to affordable uninsured health services coupled with the increased use of those services by uninsured/underinsured residents causes increased costs for hospitals.

�� DIFFICULTIES EXPERIENCED WHEN SEEKING MEDICAL SERVICES

Focus group participants expressed problems in communicating with medical staff and a lack of access to medical doctors which results in confusion, complications, lengthier healing periods, unnecessary emergency room visits and avoidance of local healthcare providers.

�� Difficulties communicating with medical staff: A select number of focus group participants suggested specialists and surgeons in the medical community offer little to no communication. These factors contribute to participants feeling uninformed.

�� Limited access to medical doctors: Participants felt they did not have

adequate access to medical doctors due to the inability to secure a same-day medical appointment, being referred to the emergency room instead of seeing a doctor, seeing a resident and/or qualified nurse instead of a doctor, and seeing a different doctor each visit.

Additional data and greater detail related to the South Pointe Hospital Community Focus Groups is available in Appendixes D - F.

��


Conclusions

The majority of community needs identified through the South Pointe Hospital community health needs assessment process are not related to the provision of traditional medical services provided by community hospitals. However, the top needs identified in this assessment do “translate” into a wide variety of health-related issues that may ultimately require hospital and or community services. For example, the absence of collaboration among community organizations, healthcare providers and support groups in the South Pointe Hospital community has caused a lack of outreach efforts and awareness regarding available programs and services. The inadequate collaboration leads to ineffective dissemination of information. Community stakeholders feel there is a lack of awareness among residents about how to access community services. Often when residents are unaware of available services the result is a lack of participation in those services, an underserved population and unmet needs. The availability of health-related educational programs and communications is a significant component to the definition of a healthy South Pointe Hospital community. The South Pointe Hospital community is a contrast of “higher need” and “lower need” areas. The northern zip code areas of the community generally have a greater number of socio-economic barriers impacting community health compared to the southern zip code areas. For example, the unemployment rate within the northern zip code area of Union/Miles – Newburgh Heights (44105) is over 16% while the southern zip code areas of Twinsburg (44087) and Solon (44139) have unemployment rates below 4%. Community focus group participants perceive a lack of adequate medical service provision due to inadequate communication from medical staff and a lack of access to medical doctors. The increased prevalence of specific chronic diseases in the South Pointe Hospital community indicates community health trends of disease that could be prevented through increased availability of preventive education and primary care. Hypertension prevalence in the South Pointe Hospital community is much higher than any of the service counties or Ohio. Diabetes, strokes and weak/failing kidneys are also more prevalent in the South Pointe Hospital community than the service counties and Ohio. Although existing programs attempt to serve the community health needs of its citizens, the need to coordinate existing efforts among community resources will ultimately lead to more effective utilization of current healthcare services. Additional data and greater detail related to an inventory of available resources within the community that may provide programs and services to meet such needs is available in Appendix G.

�


South Pointe Hospital, working closely with community partners, understands that the community health needs assessment document is only a first step in an ongoing process. To this end, the next phase of the community health needs assessment may include the following next steps:

�� Internal Communication: Widely communicate the results of the community health needs assessment document to South Pointe Hospital and Cleveland Clinic Health System staff, providers, leadership and boards.

�� External Communication: Widely communicate the results of the community health needs assessment document to community residents through multiple outlets such as: local media, neighborhood associations, community-based organizations, faith-based organizations, schools, libraries and employers.

�

APPENDIX A:

�� Hospital Community�� Key Stakeholder Organizations

��


Key Stakeholder Organizations

Representatives from the following community based organizations provided detailed input during the community health needs assessment process:

��City of Bedford Heights (Local Government) ��City of Warrensville Heights (Local Government) ��State of Ohio House of Representatives (State Government) ��Bedford City School District (Public School) ��Warrensville Heights City School District (Public School) ��South Pointe Hospital (Health Care Provider) ��Park East Care & Rehabilitation (Health Care Provider) ��Cleveland Branch NAACP (Community Organization)

��

APPENDIX B:

South Pointe Hospital Community Secondary Data Profile

��

South Pointe Service Area Community Health Needs Profile

��

Contents

�Overview of Secondary Data Methodology �Key Points�Demographic Profile�Community Need Index (CNI)�Disease Prevalence�Prevention Quality Indicators Index (PQI)�Penetrating Trauma Data�Health Behavior Profile

��

Overview of Secondary Data Methodology• Tripp Umbach obtained information on the health status and

socioeconomic/environmental factors related to health and needs of residents of multi-community service areas comprising each of the Cleveland Clinic Hospitals.

• Example data sources included the Behavioral Risk Factor Surveillance System (BRFSS), Community Need Index (CNI), Prevention Quality Indicators Index (PQI), Healthy People 2020, Ohio Trauma Registry (OTR) and other existing data sources.

• The process developed accurate comparisons to the state baseline of health measures utilizing the most current validated data.

��

Overview of Key Data SourcesCommunity Need Index (CNI)• In 2005 Catholic Healthcare West, in partnership with Thomson Reuters,

pioneered the nation’s first standardized Community Need Index (CNI). CNI was applied to quantify the severity of health disparity for every zip code in Ohio based on specific barriers to healthcare access.

• Because the CNI considers multiple factors that are known to limit health care access, the tool may be more accurate and useful than existing assessment methods in identifying and addressing the disproportionate unmet health-related needs of neighborhoods.

• The five prominent socio-economic barriers to community health quantified in CNI include: Income, Culture/Language, Education, Insurance, and Housing.

• CNI quantifies the five socio-economic barriers to community health utilizing a 5 point index scale where 5 indicates the greatest need and 1 indicates the lowest need.

• A CNI score above 3.0 will typically indicate a specific socio-economic factor impacting the communities access to care.

��

Overview of Key Data Sources

Prevention Quality Indicators Index (PQI) • The Prevention Quality Indicators index (PQI) was developed by the Agency

for Healthcare Research and Quality (AHRQ). The AHRQ model was applied to quantify the PQI within the Cleveland Clinic market and Ohio. PQI is similarly referred to as Ambulatory Care Sensitive Hospitalizations.

• The quality indicator rates are derived from inpatient discharges by zip code using ICD diagnosis and procedure codes. There are 14 quality indicators.

• The PQI index identifies potentially avoidable hospitalizations for the benefit of targeting priorities and overall community health.

• Lower index scores represent less admissions for each of the PQIs.

��

Community Demographic Profile� Hospital community is defined as a zip code geographic area based

on 80% of the hospital’s inpatient volumes. The South Pointe Community is comprised of 13 zip code areas covering portions of Cuyahoga, Portage and Summit Counties in Northeast Ohio.

� Gender, Age, Percentages of Families living in poverty and Insurance spread within the South Pointe Hospital community are consistent with service counties and Ohio.

� The South Pointe Hospital community has a slightly higher percentage of African American citizens and citizens with a Bachelor’s degree and above as compared to the service counties and Ohio.

� Average and median household income levels are slightly higher for citizens in the South Pointe Hospital community as compared to the service counties and Ohio.

� The South Pointe Hospital community unemployment rate (8.1%) is slightly higher than the overall Ohio rate (7.0%) and less than the national rate (approximately 9%).

�

South Pointe Hospital – Community Map

�

Key Points – Community Needs in the South Pointe Hospital Community

� A larger community such as the South Pointe Hospital community presents a unique challenge to hospital leadership. The South Pointe Hospital community is a contrast of “high need” and “low-need” areas. Union/Miles – Newburgh Heights (44105) records the highest CNI score (greatest need) of 4.8 and North Field (44067) and Macedonia (44056) record the lowest at 1.2; all within the same hospital community.

� Specific high need communities are Union/Miles – Newburgh Heights (44105), Shaker Heights (44120), and Bedford (44146).

� The South Pointe Hospital community unemployment rate (8.1%) is slightly higher than the overall Ohio rate (7.0%) and less than the national rate (approximately 9%). � The unemployment rate is highest within the Union/Miles – Newburgh Heights area (44105) - over 16%.� More than 25% of the Union/Miles – Newburgh Heights (44105) population has not received a high

school diploma.� Union/Miles – Newburgh Heights (44105) and Shaker Heights (44120) have the highest percentages of

citizens living in poverty within the South Pointe community, totaling over 60% of the 65 and older population.

� Union/Miles – Newburgh Heights (44105) also has the highest rates of uninsured citizens, citizens with no high school diploma and citizens living in poverty within the South Pointe Hospital community.

��


� Hypertension prevalence in the South Pointe Hospital community (333 cases per 1000 pop.) is much higher than any of the service counties (highest at 316) or Ohio (286).

� Diabetes, Strokes and Weak/Failing Kidneys are more prevalent in the South Pointe Hospital community than the service counties and Ohio.

� The South Pointe Hospital community shows lower rates of obesity, smoking, and depression as compared to service counties and Ohio. Of note, the smoking rate for the South Pointe Hospital communities is substantially lower than all local counties and Ohio.

� However, the South Pointe Hospital community shows higher rates of high blood pressure and citizens with chemical dependency compared to service counties and Ohio.

��


� PQI scores in the South Pointe Hospital community are at or above Ohio PQIs for the majority of factors.

� The South Pointe Hospital community is substantially higher within the following PQIs: �Low Birth Weight (+4.15)�Congestive Heart Failure (+2.28)�Adult Asthma (+1.64) �Urinary Tract Infection(+1.15)

� South Pointe Hospital has a penetrating trauma rate of 9.7%, somewhere in the middle across local hospital communities; with Cleveland Clinic Main campus at 21.5% and Medina at 2.4%. The rate for South Pointe Hospital is higher than all service counties and Ohio.

��

Data AppendixDemographicsCommunity Need Index (CNI)Disease PrevalencePrevention Quality Indicators Index (PQI)Penetrating Trauma DataHealth Behavior Profile

��

OverviewDemographic Profile� Hospital community is defined as a zip code geographic area based

on 80% of the hospital’s inpatient volumes. The South Pointe Community is comprised of 13 zip code areas covering portions of Cuyahoga, Portage and Summit Counties in Northeast Ohio.

� Gender, Age, Percentages of Families living in poverty and Insurance spread within the South Pointe Hospital community are consistent with service counties and Ohio.

� The South Pointe Hospital community has a slightly higher percentage of African American citizens and citizens with a Bachelor’s degree and above as compared to the service counties and Ohio.

� Average and median household income levels are slightly higher for citizens in the South Pointe Hospital community as compared to the service counties and Ohio.

� The South Pointe Hospital community unemployment rate (8.1%) is slightly higher than the overall Ohio rate (7.0%) and less than the national rate (approximately 9%).

��

2010 demographic profile data provided by Thomson Reuters was based on projection data, compiled in calendar year 2011. Adjustments to population data based on 2010 US Census data made available to the public at the zip code level in 2012 does not result in any changes to the identified community needs within the Community Health Needs Assessment Report.

Total Population

South Pointe Service Area

Cuyahoga County

PortageCounty

Summit County

Ohio

2000 350,261 1,400,071 158,191 546,134 11,353,136

2010 583,781 1,270,520 162,960 544,269 11,496,028

2015 573,859 1,199,339 163,973 538,352 11,471,127

Projected 5 year change(2010 – 2015)

-9,922 -71,181 1,013 -5,917 -24,901

Population

Source: Thomson Reuters

��


��


�


��


* 2010 Unemployment Statistics – accessed March 2011

��


��

Overview� The South Pointe Hospital community is a contrast of “high need” and

“low-need” areas. The northern zip code areas of the community generally record higher CNI scores compared to the south.� The unemployment rate is highest within the Union/Miles – Newburgh Heights

area (44105) - over 16%.� In contrast, Twinsburg (44087) and Solon (44139) have unemployment rates

below 4%. Solon (44139) has an uninsured rate of 4.2%.

� Specific high need communities are Union/Miles – Newburgh Heights (44105), Shaker Heights (44120), and Bedford (44146).� More than 25% of the Union/Miles – Newburgh Heights (44105) population

has not received a high school diploma.� More than 25% of the population in Union/Miles – Newburgh Heights (44105),

Shaker Heights (44120), and Bedford (44146) are elderly and living at poverty levels.

� Union/Miles – Newburgh Heights (44105) also has the highest rates of uninsured citizens, citizens with no high school diploma and citizens living in poverty within the South Pointe community.

� The number of families and adults 65 and older living in poverty is a barrier to community health.� Union/Miles – Newburgh Heights (44105) and Shaker Heights (44120) have

the highest percentages of citizens living in poverty within the South Pointe Hospital community, totaling over 60% of the 65 and older population.


��

Community Need Index (CNI)Five prominent socio-economic barriers to community health quantified in the CNI

• Income Barriers – Percentage of elderly, children, and single parents living in poverty

• Cultural/Language Barriers – Percentage Caucasian/non-Caucasian and percentage of adults over the age of 25 with limited English proficiency

• Educational Barriers – Percentage without high school diploma

• Insurance Barriers – Percentage uninsured and percentage unemployed

• Housing Barriers – Percentage renting houses

��

Zip City County Tot Pop HHRental

%Unemp

%Uninsu

%Minor

%LimEng

No HS Dip

65+ Pov

M w/ Chil Pov

Sin w/ Chil Pov

IncRank

InsurRank

EducRank

CultRank

HousRank

CNIScore

44105Union/Miles –Newburgh Heights Cuyahoga 47,442 18,092 36.5% 16.7% 25.1% 70.6% 6.2% 26.1% 34.1% 11.3% 50.3% 5 5 4 5 5 4.8

44120 Shaker Heights Cuyahoga 42,254 18,181 45.2% 13.1% 21.6% 81.8% 7.3% 14.8% 26.1% 8.7% 40.7% 4 4 2 5 5 444122 Beachwood Cuyahoga 31,527 12,923 28.2% 5.8% 9.2% 40.1% 10.1% 7.5% 14.4% 2.5% 20.2% 2 2 1 5 4 2.8

44128Warrensville Heights Cuyahoga 29,622 12,375 34.3% 12.3% 16.3% 97.0% 3.4% 17.6% 21.0% 6.0% 24.8% 3 4 3 5 5 4

44137 Maple Heights Cuyahoga 23,342 9,469 15.5% 7.6% 12.3% 58.9% 6.6% 13.2% 24.2% 3.6% 16.7% 2 3 2 5 2 2.844139 Solon Cuyahoga 22,641 7,944 12.5% 2.4% 4.2% 16.9% 10.6% 3.7% 8.6% 1.7% 11.0% 1 1 1 3 1 1.444146 Bedford Cuyahoga 28,913 13,096 35.0% 6.4% 13.7% 51.9% 4.8% 13.0% 25.0% 2.7% 22.3% 3 3 2 5 5 3.644202 Aurora Portage 18,427 7,209 18.8% 4.2% 5.5% 6.9% 4.0% 5.0% 11.2% 1.9% 11.8% 1 1 1 2 2 1.444241 Streetsboro Portage 15,262 6,297 29.5% 4.7% 8.0% 8.7% 4.1% 9.7% 15.6% 4.4% 14.5% 1 2 1 2 4 244056 Macedonia Summit 10,486 3,824 4.8% 5.5% 4.2% 12.4% 6.7% 4.9% 8.1% 0.1% 11.8% 1 1 1 2 1 1.244067 Northfield Summit 18,483 7,684 13.7% 4.8% 6.3% 6.3% 5.1% 6.7% 11.4% 0.9% 9.5% 1 2 1 1 1 1.244087 Twinsburg Summit 19,175 7,536 23.7% 4.1% 7.3% 21.4% 6.2% 5.0% 19.5% 0.7% 12.9% 1 2 1 2 3 1.844236 Hudson Summit 25,450 8,517 11.1% 4.2% 3.2% 8.3% 6.4% 2.1% 6.2% 2.4% 20.7% 2 1 1 2 1 1.4

South Pointe Hospital Community Summary 333,024 133,147 28.3% 8.1% 12.8% 46.1% 6.4% 11.7% 19.9% 3.6% 31.5% 3 3 2 5 4 3.4

Assigning CNI ScoresTo determine the severity of barriers to health care access in a given community, the CNI gathers data about the community’s socio-economy. For example, what percentage of the population is elderly and living in poverty; what percentage of the population is uninsured; what percentage of the population is unemployed, etc.

Using this data, we assign a score to each barrier condition. A score of 1.0 indicates a zip code with the lowest socio-economicbarriers (low need), while a score of 5.0 represents a zip code with the most socio-economic barriers (high need). The scores are thenaggregated and averaged for a final CNI score (each barrier receives equal weight in the average).

A CNI score above 3.0 will typically indicate a specific socio-economic factor impacting the communities access to care.

At the same time, a CNI score of 1.0 does not indicate the community requires no attention at all, which is why a larger community suchas the South Pointe Hospital community presents a unique challenge to hospital leadership.


��


%Unemp

%Uninsu

%Minor

%LimEng

No HS Dip

65+ Pov

M w/ Chil Pov

Sin w/ Chil Pov

IncRank

InsurRank

EducRank

CultRank

HousRank

CNIScore

44105Union/Miles –Newburgh Heights Cuyahoga 47,442 18,092 36.5% 16.7% 25.1% 70.6% 6.2% 26.1% 34.1% 11.3% 50.3% 5 5 4 5 5 4.8

44120 Shaker Heights Cuyahoga 42,254 18,181 45.2% 13.1% 21.6% 81.8% 7.3% 14.8% 26.1% 8.7% 40.7% 4 4 2 5 5 4.0

44128 Warrensville Heights Cuyahoga 29,622 12,375 34.3% 12.3% 16.3% 97.0% 3.4% 17.6% 21.0% 6.0% 24.8% 3 4 3 5 5 4.0

44146 Bedford Cuyahoga 28,913 13,096 35.0% 6.4% 13.7% 51.9% 4.8% 13.0% 25.0% 2.7% 22.3% 3 3 2 5 5 3.6

44122 Beachwood Cuyahoga 31,527 12,923 28.2% 5.8% 9.2% 40.1% 10.1% 7.5% 14.4% 2.5% 20.2% 2 2 1 5 4 2.8

44137 Maple Heights Cuyahoga 23,342 9,469 15.5% 7.6% 12.3% 58.9% 6.6% 13.2% 24.2% 3.6% 16.7% 2 3 2 5 2 2.8South Pointe Hospital Primary Market Summary 203,100 84,136 34.5% 10.9% 17.5% 68.1% 6.8% 15.9% 25.3% 5.3% 37.1% 4 3 2 5 5 3.8

The South Pointe Hospital executive leadership team requested a secondary “view” of the CNI scores forthe South Pointe Hospital community. While the overall hospital community includes 13 zip codescomprising 80% of the inpatient volume at Hillcrest Hospital, the entire community consist of two markets;primary and secondary.

The South Pointe Hospital community primary market consists of 6 zip code areas with a CNI score of 2.8or higher. Union/Miles – Newburgh Heights (44105), Shaker Heights (44120), and Warrensville Heights(44128) have CNI scores of 4.0 or higher. The South Pointe Hospital primary market, consisting of zipcodes in Cuyahoga County, have the highest health care access needs.

CNI Scores – Primary Market


�

The South Pointe Hospital community secondary market consists of 7 zip code areas with a CNI score of1.4. The secondary market comprises zip code areas with fewer barriers to health care access.

CNI Scores – Secondary Market



%Unemp

%Uninsu

%Minor

%LimEng

No HS Dip

65+ Pov

M w/ Chil Pov

Sin w/ Chil Pov

IncRank

InsurRank

EducRank

CultRank

HousRank

CNIScore

44241 Streetsboro Portage 15,262 6,297 29.5% 4.7% 8.0% 8.7% 4.1% 9.7% 15.6% 4.4% 14.5% 1 2 1 2 4 2.0

44087 Twinsburg Summit 19,175 7,536 23.7% 4.1% 7.3% 21.4% 6.2% 5.0% 19.5% 0.7% 12.9% 1 2 1 2 3 1.8

44139 Solon Cuyahoga 22,641 7,944 12.5% 2.4% 4.2% 16.9% 10.6% 3.7% 8.6% 1.7% 11.0% 1 1 1 3 1 1.4

44202 Aurora Portage 18,427 7,209 18.8% 4.2% 5.5% 6.9% 4.0% 5.0% 11.2% 1.9% 11.8% 1 1 1 2 2 1.4

44236 Hudson Summit 25,450 8,517 11.1% 4.2% 3.2% 8.3% 6.4% 2.1% 6.2% 2.4% 20.7% 2 1 1 2 1 1.4

44056 Macedonia Summit 10,486 3,824 4.8% 5.5% 4.2% 12.4% 6.7% 4.9% 8.1% 0.1% 11.8% 1 1 1 2 1 1.2

44067 Northfield Summit 18,483 7,684 13.7% 4.8% 6.3% 6.3% 5.1% 6.7% 11.4% 0.9% 9.5% 1 2 1 1 1 1.2

South Pointe Hospital Secondary Market Summary 129,924 49,011 16.7% 4.2% 5.4% 11.6% 5.9% 5.1% 12.1% 0.8% 13.4% 1 1 1 2 2 1.4

�

Community Need Index (CNI)Zip City County

Inc Rank

Insur Rank

Educ Rank

Cult Rank

Hous Rank

CNI Score

44105 Union/Miles –Newburgh Heights Cuyahoga 5 5 4 5 5 4.8

44120 Shaker Heights Cuyahoga 4 4 2 5 5 4.044128 Warrensville Heights Cuyahoga 3 4 3 5 5 4.044146 Bedford Cuyahoga 3 3 2 5 5 3.644122 Beachwood Cuyahoga 2 2 1 5 4 2.844137 Maple Heights Cuyahoga 2 3 2 5 2 2.844241 Streetsboro Portage 1 2 1 2 4 2.044087 Twinsburg Summit 1 2 1 2 3 1.844139 Solon Cuyahoga 1 1 1 3 1 1.444202 Aurora Portage 1 1 1 2 2 1.444236 Hudson Summit 2 1 1 2 1 1.444056 Macedonia Summit 1 1 1 2 1 1.244067 Northfield Summit 1 2 1 1 1 1.2

South Pointe Hospital Community 3 3 2 5 4 3.4

• Union/Miles – Newburgh Heights (44105) records the highest CNI score (greatest need) within the South Pointe community.


��


• The CNI zip code summary provides the community hospital with valuable background information to begin addressing the community needs.

• A closer look at the Union/Miles – Newburgh Heights (44105) area reveals the highest unemployment and uninsured rates, highest percentage of individuals without a high school diploma and highest rates of families living in poverty within the South Pointe Hospital community.

• The CNI provides greater ability to diagnose community need as it explores areas with significant barriers to health care access. The overall unemployment rate for the South Pointe Hospital community is 8.1%; below the national unemployment rate currently fluctuating around 9%. The unemployment rate for Union/Miles – Newburgh Heights (44105) is 16.7%, more than double the South Pointe Hospital community, state and national levels.

Zip Tot Pop HHRental

%Unemp

%Uninsu

%Minor

%Lim Eng

No HS Dip

65+ Pov

M w/ Chil Pov

Sin w/ Chil Pov

Inc Rank

Insur Rank

Educ Rank

Cult Rank

Hous Rank

CNI Score

44105 47,442 18,092 36.5% 16.7% 25.1% 70.6% 6.2% 26.1% 34.1% 11.3% 50.3% 5 5 4 5 5 4.8


��

South Pointe Hospital – CNI Map


��

Examining the overall CNI scores for the South Pointe Hospital community and the service counties, Cuyahoga County has the greatest number of socio-economic barriers to health care access; indicating greater need.


��

1.4

2.2

3.0 3.2 3.4 3.64.0

4.6 4.8 4.8

00.5

11.5

22.5

33.5

44.5

5Community Need Index - Hospital Communities


The CNI score for the South Pointe Hospital community is 3.4 out of the highest possible score of 5.0. With 4 hospital communities having lower need and 4 hospital communities having higher need, South Pointe represents the approximate average level of community health need across all hospital communities.

*

* community includes Children’s Hospital and Children’s Rehab. ��

Overview�Breast cancer & prostate cancer are the two most prevalent

forms of cancer, therefore, we note the prevalence of the two cancer types among all Cleveland Clinic hospital communities. The South Pointe Hospital community has lower prevalence rates for all cancers (excluding prostate) as compared to the service counties and Ohio.

�Hypertension prevalence in the South Pointe Hospital community (333 cases per 1000 pop.) is much higher than any of the service counties (highest at 316) or Ohio (286).

�Diabetes, Strokes and Weak/Failing Kidneys are more prevalent in the South Pointe Hospital community than the service counties and Ohio.

Disease Prevalence Profile

��


��


�


��


�

Overview Prevention Quality Indicators Index (PQI)• PQI scores in the South Pointe Hospital community are at or

above Ohio PQIs for the majority of factors. The South Pointe Hospital community is substantially higher within the following PQIs:

Prevention Quality Indicators (PQI)South Pointe Service Area

Ohio Difference

Low Birth Weight Rate (PQI 9)5.36 1.21 +4.15

Congestive Heart Failure Admission Rate (PQI 8) 6.94 4.66 +2.28

Adult Asthma Admission Rate (PQI 15)3.63 1.99 +1.64

Urinary Tract Infection Admission Rate (PQI 12) 3.81 2.66 +1.15

• PQI scores in the South Pointe Hospital community show lower admission rates than Ohio for Perforated Appendix and Bacterial Pneumonia

Source: Ohio Hospital Association

�

Prevention Quality Indicators Index (PQI)PQI Subgroups• Chronic Lung Conditions

� PQI 5 Chronic Obstructive Pulmonary Disease Admission Rate� PQI 15 Adult Asthma Admission Rate

• Diabetes� PQI 1 Diabetes Short-Term Complications Admission Rate� PQI 3 Diabetes Long-Term Complications Admission Rate� PQI 14 Uncontrolled Diabetes Admission Rate� PQI 16 Lower Extremity Amputation Rate Among Diabetic Patients

• Heart Conditions� PQI 7 Hypertension Admission Rate� PQI 8 Congestive Heart Failure Admission Rate� PQI 13 Angina Without Procedure Admission Rate

• Other Conditions� PQI 2 Perforated Appendix Admission Rate� PQI 9 Low Birth Weight Rate� PQI 10 Dehydration Admission Rate� PQI 11 Bacterial Pneumonia Admission Rate� PQI 12 Urinary Tract Infection Admission Rate

�

Chronic Lung Conditions

PQI 5 Chronic Obstructive Pulmonary Disease Admission RatePQI 15 Adult Asthma Admission Rate


�

Diabetes

PQI 1 Diabetes Short-Term Complications Admission RatePQI 3 Diabetes Long-Term Complications Admission RatePQI 14 Uncontrolled Diabetes Admission RatePQI 16 Lower Extremity Amputation Rate Among Diabetic Patients


Heart Conditions

PQI 7 Hypertension Admission RatePQI 8 Congestive Heart Failure Admission RatePQI 13 Angina Without Procedure Admission Rate


Other Conditions

PQI 2 Perforated Appendix Admission RatePQI 9 Low Birth Weight RatePQI 10 Dehydration Admission RatePQI 11 Bacterial Pneumonia Admission RatePQI 12 Urinary Tract Infection Admission Rate


�

Overview� Tripp Umbach collected statistical data from the Ohio Department of Public

Safety, Division of Emergency Medical Services, Ohio Trauma Registry, also known as OTR. The data refers to all trauma cases resulting in severe injury occurring in Ohio during 2010. OTR trauma data provides the ability to quantify the overall frequency of trauma cases by occurrence type.

� There are five types of trauma quantified by OTR: asphyxia, blunt, burns, penetrating and “other”. The consultants identified the percentage of penetrating traumas compared to the overall number of trauma cases in a zip code defined hospital community. The resulting percentage provides a secondary data source quantifying the number of violent traumas related to a foreign object or shattered bone.

� Penetrating trauma can be caused by a foreign object or by fragments of a broken bone. Usually, penetrating trauma occurs in violent crime or armed combat, penetrating injuries are commonly caused by gunshots and stabbings.

� South Pointe Hospital has a penetrating trauma rate of 9.7%, slightly higher than the average of all Cleveland Clinic hospital communities; with Cleveland Clinic Main campus at 21.5% and Medina at 2.4%. The rate for South Pointe Hospital is higher than all of the service counties and Ohio.

Penetrating Trauma Data

�

Source: Ohio Trauma Registry

2010 Trauma: % Penetrating

9.7%8.7%

2.0%

3.5%

6.7%

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

South Pointe Service Area

Cuyahoga County

Portage County

Summit County

Ohio

21.5%

9.2%

3.2% 3.5%

19.9%

4.3%

9.2%

5.5%

2.4%

9.7%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

2010 Trauma by Community: % Penetrating

Penetrating trauma data is based on the residence zip code of the trauma patient, not where the trauma was treated or occurred.

�

Overview � Data for obesity, smoking and high blood pressure were obtained from the 2010 Behavioral Risk Factor Surveillance System. The Behavioral Risk Factor Surveillance System (BRFSS) is a state-based system of health surveys that collects information on health risk behaviors, preventive health practices, and health care access primarily related to chronic disease and injury. Data for this analysis was provided by Thomson Reuters.

� Data related to chemical dependency and depression were obtained from the Ohio Hospital Association (OHA), based on 2010 substance abuse and depression related Diagnosis Related Groups (DRGs) prevalence within the zip code defined geography of each hospital community.

� The South Pointe Hospital community shows lower rates of obesity, smoking, and depression as compared to service counties and Ohio. Of note, the smoking rate for the South Pointe Hospital communities is substantially lower than all local counties and Ohio.

� However, the South Pointe Hospital community shows higher rates of high blood pressure and citizens with chemical dependency compared to service counties and Ohio.

Health Behavior Profile

�

256.9

289.2

241.2

258.4

288.2

254.4255.0

239.1

281.7

254.7

271.9

255.4

261.8

273.7268.6

200.0

210.0

220.0

230.0

240.0

250.0

260.0

270.0

280.0

290.0

300.0

Obesity High Blood Pressure

Smoking

South Pointe Service AreaCuyahoga CountyPortage CountySummit CountyOhio


�

3.10

0.40

4.75

0.40

2.13

0.64

2.93

0.72

3.06

0.64

0.00

0.50

1.00

1.50

2.00

2.50

3.00

3.50

4.00

4.50

5.00

Chemical Dependency Depression

South Pointe Service AreaCuyahoga CountyPortage CountySummit CountyOhio


�

APPENDIX C:

South Pointe Hospital Interview Summary -- Key Stakeholder Group

�

COMMUNITY�STAKEHOLDER�INTERVIEW�SUMMARY�

Community:�

South�Pointe� ��area�

Data�Collection:�

The� following�qualitative� data�were�gathered� during� individual� interviews�with�eleven� stakeholders�of�the� South� Pointe� area� as� identified� by� an� advisory� committee� of� South� Pointe� Hospital� executive�leadership.�South�Pointe�Hospital�is�a�213�bed�acute�care,�community�teaching�hospital�and�also�one�of�nine�Cleveland�Clinic�community�hospitals�in�Northeast�Ohio.�Each�interview�was�conducted�by�a�Tripp�Umbach�consultant�and�lasted�approximately�sixty�minutes.�All�respondents�were�asked�the�same�set�of�questions� previously� developed� by� Tripp� Umbach� approved� by� the� South� Pointe� Hospital� executive�leadership�project�team�(See�Appendix�1).��

Summary�of�Stakeholder�Interviews:��

QUESTION� #1:� Please� tell� us� what� community� you� are� speaking� on� behalf� of,� such� as� a� region,�

county,�city,�town�or�a�neighborhood.�Please�be�specific.��

The�five�places�mentioned�by�stakeholders�when�asked�what�community�they�were�speaking�on�behalf�of�were:�Warrensville�Heights,�Bedford�Heights,�Cleveland,�The�East�Side�of�Cleveland,�and�Beachwood,�Ohio�(in�order�of�most�mentioned).��

QUESTION�#2:�How�long�have�you�lived�in�this�community?�

Of�the�eleven�respondents�eight�currently�lived�in�the�community�and�three�worked�in�the�community�but�did�not�reside�there.�Of�the�eight�residents,�the�shortest�length�of�residency�was�one�year�and�the�longest�was�at�least�fifty�years.�The�median�length�of�residency�was�33.5�years�and�the�mean�length�of�residency� was� 25.3� years.� Of� the� three� respondents� whom� were� employed� but� did� not� reside� in� the�community,�the�shortest�length�of�employment�was�eight�years�and�the�longest�was�more�than�23�years.�The�median�length�of�employment�was�17�years�and�the�mean�length�of�employment�was�16�years.��

QUESTION�#3:�Your�position�in�the�community?�

Of�the�eleven�respondents�there�was�a�diverse�representation�of�positions�held�in�the�community.�Those�positions� represented� included� educational� leader,� educator,� political� leader,� community� leader,� non�profit�leader,�medical�department�chair,�political�staff�person,�and�nursing�home�administrator.�

� �

�

QUESTION�#5:�How�would�you�describe�a�healthy�community?�

There�were�six� themes� identified�upon�review�of� the�stakeholders’� collective�definitions�of�a�“healthy�community”.� These� were:� Access� to� healthy� food,� Access� to� health� care,� Recreational� opportunities,�Physically� and� mentally� healthy� residents,� A� strong� economy� and� Educational� opportunities.� Other�elements� of� a� health� community� mentioned� by� at� least� one� stakeholder� were:� respect,� diversity,�collaboration,�daycare�services,�affordable�housing,�safety�and�adequate�green�space.��

Access� to� healthy� food� was� identified� by� six� stakeholders� as� significant� to� the� definition� of� a� healthy�community.� Specifically,� stakeholders� mentioned� the� following� elements� relating� to� access� to� healthy�food�that�a�healthy�community�should�have:�

� Quality�healthy�food�that�is�readily�available�to�its�residents�� Access�to�fresh�food�� Grocery�stores�� Gardening�throughout�the�community��

Access� to� health� care� was� identified� by� five� stakeholders� as� significant� to� the� definition� of� a� healthy�community.� Specifically,� stakeholders� mentioned� the� following� elements� relating� to� access� to� health�care�that�a�healthy�community�should�have:�

� Access�to�quality�healthcare�� Adequate�healthcare�� Ability�to�identify�thresholds�for�disease�� Hospital�services�� Good�preventive�primary�care�� Accessible�primary�care�facilities�� Available�and�flexible�office�appointments�� Continuing�care�� Confidence�in�the�community�hospital�

�

Recreational� opportunities� were� identified� by� five� stakeholders� as� significant� to� the� definition� of� a�healthy�community.�Specifically,�stakeholders�mentioned�the�following�elements�relating�to�recreational�opportunities�that�a�healthy�community�should�have:�

� Recreational�facilities�� Recreational�activities�for�the�residents�� Access�to�parks�and�areas�to�walk,�run�and�exercise�� People�are�engaged�to�do�healthy�things��

�

Physically� and� mentally� healthy� residents� were� identified� by� four� stakeholders� as� significant� to� the�definition�of�a�healthy�community.�Specifically,�stakeholders�mentioned�the�following�elements�relating�to�physically�and�mentally�healthy�residents�that�a�healthy�community�should�have:�

� A�positive�outlook�on�both�physical�health�and�mental�health�� Access�to�exercise�programs�� The�ability�to�feed�both�body�and�mind�� Ability�to�be�strong�physically��

�

A� strong� economy� was� identified� by� three� stakeholders� as� significant� to� the� definition� of� a� healthy�community.�Specifically,�stakeholders�mentioned�the�following�elements�relating�to�a�strong�economy�that�a�healthy�community�should�have:�

� Access�to�job�opportunities�� Residents�and�businesses�functioning�cohesively�� Enough�residents�for�businesses�and�vice�versa�� Support�that�allows�a�resident�to�be�productive�� Strong�business�� Opportunities�for�the�community�

�

Educational� opportunities� were� identified� by� three� stakeholders� as� significant� to� the� definition� of� a�healthy�community.�Specifically,�stakeholders�mentioned�the�following�elements�relating�to�educational�opportunities�that�a�healthy�community�should�have:�

� Good�schools�� A�strong�commitment�to�neighborhood�schools�� Ability�to�be�strong�educationally��

�

QUESTION�#5a:�Is�this�a�healthy�community?�

Out�of�eleven�responses,� two�stakeholders� felt� their�community�was�healthy;�six� felt� their�community�was� not� healthy;� and� three� stakeholders� felt� their� community� was� somewhat� healthy� but� could� be�healthier.��

Some�of�the�reasons�stakeholders�stated�they�believed�the�South�Pointe�area�was�healthy�were:�

� The�city�has�adequate�housing�� A�new�YMCA�is�being�built�� Has�a�great�hospital�� There�are�a�variety�of�good�stores�� Residents�do�not�need�to�go�outside�of�the�community�� Has�developed�a�health�initiative�

�

Some�of�the�reasons�stakeholders�stated�they�did�not�believe�the�South�Pointe�area�was�healthy�were:��

� The�community�is�not�focused�on�being�healthy�� Does�not�meet�healthy�criteria�standards�� A�majority�of�the�people�are�overweight�� It�could�be�healthier�� The�community�is�economically�depressed�� A�lot�of�businesses�have�closed�� There�are�a�lot�of�foreclosures�� The�majority�of�kids�in�school�are�on�free�and�reduced�lunch�plans�

�

QUESTION�#5b:�How�can�you�achieve�a�healthy�community?�

Out� of� eleven� responses,� one� stakeholder� stated� they� felt� their� community� had� already� achieved� a�healthy� status.� Upon� review� of� the� other� ten� stakeholders’� responses� the� following� methods� were�identified�as�being�effective�in�achieving�a�healthy�community.��

� Work�on�economic�development�(e.g.�bring�in�new�business�and�maintain�current�business)�� Provide�job�opportunities�� Provide�sustainability�for�the�inner�city�and�lower�income�residents�� Provide�the�tools�to�succeed�� Make�healthcare�easily�accessible�(i.e.�a�primary�care�clinic�should�provide�a�sliding�scale�fee)�� Improve�scheduling�done�by�healthcare�facilities�and�the�hospital�� Hospital� should� provide� outreach� to� residents,� support� to� the� community� and� promote�

awareness�� Build�healthcare�centers�that�reach�out�to�the�community�� Provide�better�training�to�staff�at�the�facilities�� Increase�awareness�through�networking,�collaboration�and�outreach�� Educate�the�community�on�healthy�living�� Improve�the�overall�well�being�of�the�community�� Enforce�housing�codes�and�provide�adequate�housing�� Provide�recreational�programs�for�families�including�after�school�activities�for�youths�� Create�green�space�and�health�initiatives�� Improve�infrastructure�� Provide�a�safe�environment�for�residents�� Provide�accessible�healthy�food�for�the�residents�� The�school�system�needs�to�get�its�act�together��

QUESTION�#6:�Please�describe�your�vision�of�what�your�community�should�look�like�in�5�10�years?�

The�eleven�stakeholders� interviewed�identified�the�following�factors� in�their�visions�of�what�the�South�Pointe�area�should�look�like�in�five�to�ten�years: �

� It�will�have�a�lot�of�green�space��

�

� Essential�services�will�be�in�walking�distance�� The�YMCA�will�provide�a�number�of�recreational�activities�� The�educational�system�will�be�improved�� The�city�will�promote�both�mental�and�physical�health�� All� the� residents� needs� will� be� met� by� a� great� hospital� and� city� services� regardless� of� socio�

economic�status�� It� will� be� a� place� where� health� initiatives� are� in� place� and� residents� are� encouraged� to� live�

healthy� lifestyles� through� promotion� of� healthy� choices� (e.g.� walking� and� eating� healthy)� and�healthy�food�will�be�available�to�residents�including�students�

� Members�of�the�community�will�take�more�responsibility�for�their�health�and�lifestyles�� There�will�be�a�strong�hospital�that�provides�outreach�and�services�� The�community�will�be�a�thriving�safe�and�comfortable�place�to�live�where�residents�have�a�good�

quality�of�life�� There� will� be� growth� of� sustainable� businesses� in� the� community� (i.e.� technology�based�

businesses)� that� will� be� strong� economically� providing� residents� with� jobs� and� the� decreasing�the�unemployment�rate��

� The�community�will�have�adequate�housing�for�seniors,�disabled�and�families�� There�will�be�more�connection�between�all�levels�of�the�community�� There�will�be�an�increase�in�foreclosures,�families�in�need�and�academic�challenges��

QUESTION� #7:� In� order� to� achieve� your� vision� of� a� healthy� community,� talk� about� some� of� the�

strengths/resources�this�community�has�to�build�upon.�List�strengths/resources�this�community�could�build�on�and�describe�how�those�strengths/resources�could�be�used?�

The�eleven�stakeholders�interviewed�identified�the�following�strengths/resources�and�their�benefits:

� Community�services:�o An�active�police�force�o Hospitals�and�long�term�care�facilities�o Healthcare�systems�working�together�to�provide�progressive�medical�care�o The�hospital�provides�educational�health�forums�and�seminars�o City�government��o Partnership�between�the�city�and�the�hospital�o Superintendent�plans�to�develop�partnership�with�the�city�o The�school�district�is�committed�to�the�children�and�their�families�o Colleges�offer�a�multitude�of�programs��o Recreation�programs��

� A�safe�community:�o Low�crime��

� An�attractive�place�to�live�and�do�business:�o Recent�ten�million�dollar�infrastructure�investment�o Affordable�and�attractive�housing�stock�o Centrally�located�o New�businesses�coming�into�the�community�o Corporations�are�strong�and�giving�back�to�the�community��

��

o Financially�strong�� Quality�residents:�

o Strong�cultural�connections�o Different�types�of�nationalities��o There�are�solid,�good�people�in�the�community�

QUESTION�#8:�In�your�opinion,�what�do�you�think�are�the�2�most�pressing�problems�and/or�barriers�

facing�residents�in�your�community�that�is�holding�your�community�back�from�achieving�your�vision?�Please�explain�why.�

The� eleven� stakeholders� interviewed� identified� the� following� problems� and/or� barriers� as� holding� the�residents�of�the�South�Pointe�area�back�from�achieving�their�previously�defined�visions:�

� Lack�of�resident�responsibility:�o Lack�of�awareness�(i.e.�residents�do�not�know�how�to�access�services)��o Lack�of�parental�involvement�in�the�school�system��o Lack�of�community�commitment�to�help�families�with�young�children�o Single�parents�are�stretched�to�the�limit�and�cannot�meet�their�child’s�needs��o Working�parents�do�not�set�good�eating�and�habits�for�their�children��o Parents�are�not�exercising�and�eating�healthy��o Families�are�not�working�together�in�a�holistic�way�

� Lack�of�access�to�and�education�about�healthy�options:�o People�are�not�educated�on�how�to�live�healthy�o No�healthy�grocery�store�chains�o Too�many�fast�food�restaurants�o No�engagement�of�people�in�the�community�wanting�to�become�healthy��

� Meeting�the�needs�of�an�aging�population:�o Less� capable� of� doing� things� for� themselves� (e.g.� mowing,� snow� removal� and�

transportation)��o Puts�a�burden�on�the�city�

� Financial�resources�are�scarce:��o Funds�are�scarce�o State�dollars�have�cut�back�o Increase�in�city�taxes�to�maintain�services�o Increased�unemployment�o Decreased�socio�economic�status��o Lack�of�sustainable�jobs�

� Poor�infrastructure:��o Limited�housing�o Poor�roads�and�sidewalks�o Lack�of�parks�and�a�recreation�center��o Traffic�and�delays�due�to�inability�to�support�population�growth�

� Safety:�o Residents’�perception�of�safety�in�the�community�is�negative�o There�is�crime�but�not�as�much�as�residents�perceive��

��

� School�system:�o Poor�education�

�

QUESTION�#9:�Do�you�believe�there�are�adequate�community�resources�available�to�address�these�

issues/problems?�

Out�of�eleven�responses,�seven�stakeholders�responded�that�they�believe�there�are�adequate�resources�available�in�the�South�Pointe�area�to�address�the�aforementioned�issues/problems.�Three�stakeholders�did�not�believe�adequate�resources�were�available�and�one�stakeholder�was�not�sure.��

Several�stakeholders�that�believed�there�were�adequate�community�resources�to�resolve�the�previously�identified�problems/issues�also�felt�that�resources�could�be�improved�and/or�ensured�by:�developing�an�outreach� program� for� the� community,� increasing� collaboration,� identifying� leadership� to� move�communities�in�a�positive�direction,�improving�delegation�and�smart�strategic�use�of�available�resources,�preparing�for�resources�to�continue�to�shrink�and�continuing�to�increase�employment�with�an�influx�of�new�businesses.��

The� three� stakeholders� that� believed� there� were� not� adequate� community� resources� to� resolve� the�previously�identified�problems/issues�cited�the�need�for�new�partnerships�and�connections�throughout�the�community,�a�lack�of�state�funding�and�a�limited�police�force�as�the�basis�for�their�beliefs.��

�

QUESTION�#10:�Do�you�see�any�emerging�community�needs�in�the�future�that�were�not�mentioned�

previously?�

Several�additional�concerns�were�mentioned�and�previously�expressed�concerns�were�expounded�upo�:

� The�hospital�needs�to�communicate�better�with�the�community.�� There�is�a�fear�that�South�Pointe�Hospital�might�be�leaving�the�community.�� There�is�not�enough�citywide�recreation�for�the�community�to�get�involved�in.�� More� young� adults� are� moving� back� home� which� can� be� solved� by� providing� better� jobs� for�

youth.�� The� health� and� wellness� of� children� is� not� being� addressed� because� children� are� overweight,�

have�multiple�allergies�and�disabilities.�� Political� leaders� can� become� more� proactive� in� the� reduction� of� Trans� fats� in� fast� food�

restaurants.��

QUESTION�#11:�Any�additional�comments�or�questions?��

� The�community�needs�to�rethink�how�they�do�things.�The�community�needs�to�work�together.�The�business�world�and�healthcare�world�do�not�work�together;�there�is�no�connection.�

��

Two out of the eleven stakeholders interviewed chose to provide additional comments. Below are the additional comments made by stakeholders:

� Warrensville�Heights� is�a�wonderful�community.�The�community� is�a�place�willing�to� learn�and�the�residents�are�feeling�empowered�to�be�proactive�and�take�control�of�their�own�health.�You�can�live�a�good,�long,�healthy�life�if�you�take�more�responsibility.�

�

�

�

�

�

�

�

�

�

�

�

�

�

�

�

�

�

�

�

�

��

APPENDIX�1:�

��

��

�

��

APPENDIX D:

South Pointe Hospital Focus Group Summary -- Residents Familiar with Diabetic Issues Group

97

RESIDENTS�THAT�ARE�FAMILIAR�WITH�DIABETIC�ISSUES�FOCUS�GROUP�INPUT�

Community:�

South�Pointe�Hospital�service�area�

INTRODUCTION:�

The� following� qualitative� data� were� gathered� during� a� discussion� group� conducted� with� a� target�population�of�residents�that�are�familiar�with�diabetic� issues�in�the�South�Pointe�Hospital�service�area.�The� target� population� was� defined� by� an� advisory� committee� of� South� Pointe� Hospital� executive�leadership.�South�Pointe�Hospital�is�a�213�bed�acute�care,�community�teaching�hospital�and�also�one�of�nine�Cleveland�Clinic� community�hospitals� in�Northeast� Ohio.� The� discussion� group�was� conducted� by�Tripp�Umbach�consultants�and�was� located�at� the�Southeast�YMCA.�Each�participant�was� provided�an�incentive�of� twenty�five�dollars� for�participating.�Discussion�groups�were�conducted�using�a�discussion�guide� previously� created� by� Tripp� Umbach� and� reviewed� by� the� South� Pointe� Hospital� executive�leadership�project�team.�The�purpose�of�this�discussion�group�was�to�identify�health�issues�and�concerns�affecting� residents�with�diabetes� in� the�South�Pointe�Hospital� service�area�as�well�as�ways� to�address�those�concerns�for�this�specific�population.�

GROUP�RECOMMENDATIONS:��

The�group�provided�many� recommendations� to�address�health� issues�and�concerns� for� residents�with�diabetes� that� live� in� the� South� Pointe� Hospital� service� area.� Below� is� a� brief� summary� of� the�recommendations:�

� Provide� a� bi�monthly� community� forum� at� the� YMCA:� The� YMCA� should� host� a� community�forum�every� two�months� in�which�a�broad� range�of�community� issues�are�discussed� including�information� about� available� programs� and� services� as� well� as� programs� and� services� that� are�needed.�The�forums�should�involve�residents�of�all�ages.�Providing�a�community�forum�at�regular�intervals� would� increase� collaboration� and� information� sharing� and� unite� residents.� Currently�there� is� little� collaboration� taking� place� in� the� community� and� residents� do� not� discuss�community�issues�on�a�regular�basis.��

� Increase� dissemination� of� information:� Information� should� be� disseminated� more� extensively�using�a�variety�of�methods�such�as�media�outlets,�community�newsletters,�event�flyers,�resource�booklets� and� canvassing� the� neighborhood.� Increasing� information� dissemination� would�decrease� confusion� and� increase� residents’� awareness� about� and� participation� in� events,�programs�and�services.�Currently�many�residents�are�unaware�of�events,�programs�and�services�available�in�the�community.��

� Residents� should� inform� themselves:� Residents� should� enroll� in� available� associations,� clubs,�and� programs� that� disseminate� information.� Enrolling� in� programs� that� provide� information�would�provide�a�link�to�the�community�and�increase�residents’�awareness�of�and�participation�in�events�programs�and�services.��

�

�� Provide�community�specific�pamphlets�about�available�programs�and�services:�Cleveland�Clinic�

should� provide� pamphlets� that� are� community� specific� in� a� similar� format� to� the� Healthwise�Handbook.� Providing� a� community� specific� resource� pamphlet� would� inform� residents� of�programs� and� services� Cleveland� Clinic� offers� in� their� communities.� Informing� residents� of�programs� and� services� available� to� them� could� decrease� confusion� and� increase� their�participation� in� those� programs� and� services.� � Currently� residents� are� not� sure� where� to� seek�medical�services�or�what�is�available�to�them.��

� Increase� community� collaboration:� � Communities� need� to� increase� collaboration� on� all� levels�including�with�South�Pointe�Hospital.�South�Pointe�Hospital�could�involve�residents�from�each�of�the�communities�they�serve�in�the�planning�and�implementation�of�their�annual�fair.�Increasing�collaboration� with� residents� would� bring� residents� together� in� a� meaningful� way,� develop� a�connection� between� communities� and� the� hospital� and� increase� the� relevance� of� the� fair� to�communities�served.��

� Residents� take� responsibility� for� their�own�care:�Residents�should�take�responsibility� for�their�own� care� by� writing� down� their� health� questions� before� they� leave� the� house� for� a� medical�appointment� and� making� sure� they� get� answered� by� the� doctor� during� their� visit.� By� taking�responsibility�for�their�own�care�residents�are�better�able�to�communicate�their�needs�to�their�doctor�and�ensure�those�needs�are�met.��

� Increase�the�number�of�community�health�fairs:�South�Pointe�has�a�terrific�turnout�to�all�of�their�health�fairs.�They�should�build�on�that�connection�with�the�community�and�hold�additional�fairs�and�events�that�focus�on�health�prevention�and�education.�Increasing�the�number�of�health�fairs�would�increase�residents’�awareness�about�preventive�education�and�increase�healthy�behavior�in�the�community.��

� Residents�could�request�prescription�medications�from�drug�companies:�Lower�income�diabetic�residents� that� cannot� afford� their� prescriptions� on� an� ongoing� basis� should� contact� the� drug�companies.� Often� drug� companies�will� subsidize� the�cost�of� prescriptions�or� provide� them� for�free� if� patients� cannot� afford� them.� Seeking� financial� help� for� prescription� medications� can�ensure�diabetic�residents�remain�healthy�and�take�their�medication�regularly.��

� Provide� a� regional� directory� of� diabetic� resources:� Hospitals,� clinics� and� pharmacies� should�collaborate� with� the� Diabetic� Association� of� Greater� Cleveland� to� publish� a� directory� of�resources�available�in�the�region�for�diabetic�patients.�There�are�many�resources�for�lower�cost�and/or�free�prescriptions�and�testing�equipment� including�strips.�A�regional�resource�directory�would�guide�diabetic�residents�in�their�search�for�the�materials�they�need�to�remain�healthy�and�safe.��

� Provide� diabetic� prevention� education:� South� Pointe� Hospital� should� work� with� each�community� to� offer� classes� and� training� on� diabetes� prevention� and� wellness� to� diabetic�residents.� Potential� topics� could� include� healthy� cooking,� grocery� shopping,� nutrition,� testing�and�responding�to�high/low�blood�sugar�readings�(e.g.�Giant�Eagle�offers�a�diabetic�class�taught�by� a� nutritionist).� Providing� additional� prevention� education� may� reduce� the� prevalence� of�diabetes�and�increase�the�wellness�of�diabetic�residents.��

��

PROBLEM�IDENTIFICATION:��

During� the� discussion� group� process,� residents� that� are� familiar� with� diabetic� issues� discussed� four�health�issues�and�concerns�in�their�community.�These�were:�

1. Lack�of�collaboration�and�information�dissemination�2. Limited�access�to�primary�and�preventive�health�care�3. Inadequate�community�services�4. Limited�access�to�transportation��

LACK�OF�COLLABORATION�AND�INFORMATION�DISSEMINATION��

Residents� that� are� familiar� with� diabetic� issues� indicated� that� there� is� a� lack� of� collaboration� and�information�dissemination�among�organizations�in�the�community�causing�service�duplication,�a�lack�of�awareness�and�confusion�among�residents.��

Contributing�Factors:�

� All� groups� in� the� community� are� not� sharing� information� or� collaborating� with� one� another�limiting�residents’�access�to�information,�causing�service�duplication�and�a�lack�of�participation�in�community�events�programs�and�services.�

� Programs�and�services�are�duplicated�in�the�community�(i.e.�Silver�Sneakers�program�is�offered�at�the�YMCA�and�community�center).��

� Many�residents�are�not�aware�of�events,�programs�and�services�available�in�their�communities.�� Information�about�available�events,�programs�and�services�is�not�well�publicized�causing�a�lack�

of� awareness� and� confusion� (e.g.� United� Way’s� #211� referral� service,� clinic� locations,� health�fairs,�etc.).��

� Some� facilities� do� not� offer� the� same� services� that� other� facilities� offer� making� it� difficult� to�determine�where�to�go�for�specific�services�(i.e.�Some�METRO�facilities�do�not�have�services�that�other�facilities�offer).�

�

Mitigating�Resources:�

Residents� that� are� familiar� with� diabetic� issues� identified� the� following� resources� in� their� community�that�they�felt�could�help�increase�collaboration�and�access�to�information:�

� United�Way�#211�referral�service�is�helpful�if�you�have�issues�� Maple�Heights�publishes�and�disseminates�a�newsletter�� Kaiser�Health�Insurance�provides�a�directory�of�doctors�and�facilities�� Shaker� Heights� provides� a� welcome� package� to� new� residents� with� coupons,� phone� numbers�

and�maps�of�the�community�� Shaker�Lights,�a�magazine,�provides�information�about�community�events�� Cleveland� Clinic� publishes� a� booklet� that� offers� community� residents� information� regarding�

programs��

��

Group�Suggestions/Recommendations:�

Residents� that�are� familiar� with� diabetic� issues� offered� the� following�as� possible� solutions� to� increase�collaboration�and�access�to�information�in�their�community:�

� Provide� a� bi�monthly� community� forum� at� the� YMCA:� The� YMCA� should� host� a� community�forum�every� two�months� in�which�a�broad� range�of�community� issues�are�discussed� including�information� about� available� programs� and� services� as� well� as� programs� and� services� that� are�needed.�The�forums�should�involve�residents�of�all�ages.�Providing�a�community�forum�at�regular�intervals�would�increase�collaboration�and�information�sharing�and�unite�residents.��

� Increase� dissemination� of� information:� Information� should� be� disseminated� more� extensively�using�a�variety�of�methods�such�as�media�outlets,�community�newsletters,�event�flyers,�resource�booklets� and� canvassing� the� neighborhood.� Increasing� information� dissemination� would�decrease� confusion� and� increase� residents’� awareness� about� and� participation� in� events,�programs�and�services.��

� Residents� should� inform� themselves:� Residents� should� enroll� in� available� associations,� clubs,�and� programs� that� disseminate� information.� Enrolling� in� programs� that� provide� information�would�provide�a�link�to�the�community�and�increase�residents’�awareness�of�and�participation�in�events�programs�and�services.��

� Provide�community�specific�pamphlets�about�available�programs�and�services:�Cleveland�Clinic�should� provide� pamphlets� that� are� community� specific� in� a� similar� format� to� the� Healthwise�Handbook.� Providing� a� community� specific� resource� pamphlet� would� inform� residents� of�programs� and� services� Cleveland� Clinic� offers� in� their� communities.� Informing� residents� of�programs� and� services� available� to� them� could� decrease� confusion� and� increase� their�participation�in�those�programs�and�services.��

� Increase� community� collaboration:� � Communities� need� to� increase� collaboration� on� all� levels�including�with�South�Pointe�Hospital.�South�Pointe�Hospital�could�involve�residents�from�each�of�the�communities�they�serve�in�the�planning�and�implementation�of�their�annual�fair.�Increasing�collaboration� with� residents� would� bring� residents� together� in� a� meaningful� way,� develop� a�connection� between� communities� and� the� hospital� and� increase� the� relevance� of� the� fair� to�communities�served.��

�

LIMITED�ACCESS�TO�PRIMARY�AND�PREVENTIVE�HEALTH�CARE:�

Residents� that� are� familiar� with� diabetic� issues� indicated� that� there� is� limited� access� to� primary� and�preventive�health�care�as�the�result�of� insurance�restrictions,�a� lack�of�services,�poor�service�provision�and/or�residents�being�uninsured�or�underinsured.��


� Insurance� restrictions� limit� access� to� primary� and� preventive� care� for� residents� with� diabetes�due�to�limited�coverage�of�pre�existing�conditions.��

��

� There� are� not� many� health� care� resources� for� uninsured/underinsured� residents� of� Bedford�Heights.��

� Silver�sneakers,�a�fitness�program�for�seniors,�is�covered�by�some�health�insurance�plans�and�not�by�others�causing�residents�to�pay�out�of�pocket�sometimes�as�much�as�$103.00�dollars�every�three�months�to�participate.��

� Uninsured� residents� find� it� difficult� to� get� medical� care� and� at� times� the� process� can� be�cumbersome�(i.e.�paperwork�required�to�be�rated�at�METRO).��

� Some�residents�do�not�take�responsibility�for�their�own�wellbeing.�� Diabetic� residents� indicated� it� is� difficult� to� secure� affordable� prescriptions� and� testing�

equipment�on�an�ongoing�basis.�� New� patients� seeking� medical� services� at� METRO� Hospital� are� asked� if� they� mind� seeing� a�

resident.�Many�participants�did�not�like�the�idea�of�being�seen�by�a�resident�instead�of�a�medical�doctor.��

� Walk�in�medical�services�are�not�readily�available�and�many�participants�indicated�it�is�difficult�to�get�to�a�scheduled�appointment�on�time�due�to�transportation�issues.��

� There� is� not� enough� outreach� about� preventive� care� such� as� health� fairs,� trainings,� seminars,�nutritional�classes,�etc.�

� Participants� felt� that� Cleveland� Clinic� classes� were� generic,� expensive� and� provided� limited�practical�information.��

� Residents� indicated� it� is� difficult� to� practice� prevention� as� a� result� of� healthy� food� being�unaffordable�and�an�increase�in�the�prevalence�of�unhealthy�eateries�in�the�community.��

�


Residents� that� are� familiar� with� diabetic� issues� identified� the� following� resources� in� their� community�that�they�felt�could�improve�access�to�primary�and�preventive�health�care:�

� Financial�subsidy�for�classes�including�Silver�Sneakers�is�available�at�the�YMCA�� Most�participants�do�not�have�problems�getting�a�medical�appointment�� Lee�Harbor�House�takes�walk�in�appointments�� NEON�is�available�but�is�difficult�to�get�to�� There�are�multiple�excellent�health�resources�available�� A�diabetic�nurse�is�available�to�check�on�patients�monthly�� A�nurse�hotline�is�available�to�provide�information�and�answer�questions�� Kaiser�provides�phone�appointment�with�a�doctor�� METRO�allows�patients�to�choose�to�see�a�resident�or�medical�doctor�� Residents� tend� to� be� more� thorough� than� attending� physicians� and� provide� follow�up� with�

patients�� South�Pointe�has�high�attendance�rates�at�their�health�fairs�� Diabetes� Association� of� Greater� Cleveland� provides� prevention� services� (i.e.� classes� about�

cooking,� grocery� shopping� with� diabetes,� how� to� do� correct� readings� and� responding� to�low/high�blood�sugar)�

� Giant�Eagle�will�provide�free�prescriptions�� METRO�social�services�will�help�patients�secure�free�diabetic�equipment��

�

��


Residents� that� are� familiar� with� diabetic� issues� offered� the� following�as� possible� solutions� to� improve�access�to�primary�and�preventive�health�care�in�their�community:��

� Residents� take� responsibility� for� their�own�care:�Residents�should�take�responsibility� for�their�own� care� by� writing� down� their� health� questions� before� they� leave� the� house� for� a� medical�appointment� and� making� sure� they� get� answered� by� the� doctor� during� their� visit.� By� taking�responsibility�for�their�own�care�residents�are�better�able�to�communicate�their�needs�to�their�doctor�and�ensure�those�needs�are�met.��

� Increase�the�number�of�community�health�fairs:�South�Pointe�has�a�terrific�turnout�to�all�of�their�health�fairs.�They�should�build�on�that�connection�with�the�community�and�hold�additional�fairs�and�events�that�focus�on�health�prevention�and�education.�Increasing�the�number�of�health�fairs�would�increase�residents’�awareness�about�preventive�education�and�increase�healthy�behavior�in�the�community.��

� Residents�could�request�prescription�medications�from�drug�companies:�Lower�income�diabetic�residents� that� cannot� afford� their� prescriptions� on� an� ongoing� basis� should� contact� the� drug�companies.� Often� drug� companies�will� subsidize� the� cost�of�prescriptions�or� provide� them� for�free� if� patients� cannot� afford� them.� Seeking� financial� help� for� prescription� medications� can�ensure�diabetic�residents�remain�healthy�and�take�their�medication�regularly.��

� Provide� a� regional� directory� of� diabetic� resources:� Hospitals,� clinics� and� pharmacies� should�collaborate� with� the� Diabetic� Association� of� Greater� Cleveland� to� publish� a� directory� of�resources�available�in�the�region�for�diabetic�patients.�There�are�many�resources�for�lower�cost�and/or�free�prescriptions�and�testing�equipment� including�strips.�A�regional�resource�directory�would�guide�diabetic�residents�in�their�search�for�the�materials�they�need�to�remain�healthy�and�safe.��

� Provide� diabetic� prevention� education:� South� Pointe� Hospital� should� work� with� each�community� to� offer� classes� and� training� on� diabetes� prevention� and� wellness� to� diabetic�residents.� Potential� topics� could� include� healthy� cooking,� grocery� shopping,� nutrition,� testing�and�responding�to�high/low�blood�sugar�readings�(e.g.�Giant�Eagle�offers�a�diabetic�class�taught�by� a� nutritionist).� Providing� additional� prevention� education� may� reduce� the� prevalence� of�diabetes�and�increase�the�wellness�of�diabetic�residents.��

�

INADEQUATE�COMMUNITY�SERVICES:�

Residents�that�are�familiar�with�diabetic�issues�indicated�that�community�services�are�inadequate�due�to�funding�cuts,�a�lack�of�facilities,�poor�service�provision,�and�the�absence�of�outreach�efforts.�


� State�funding�to�many�communities�and�community�based�organizations�is�being�cut�causing�a�dearth�of�resources�for�activities�such�as�outreach�and�prevention.�

��

� Some� communities� do� not� have� adequate� community� services� (i.e.� Maple� Heights� lacks� a�community�center).��

� Some� participants� indicated� that� staff� can� be� unfriendly� at� facilities� where� they� seek� medical�treatment.��

� Participants�felt�there�were�not�adequate�community�services�available�for�adolescents.�� Participants�expressed�an�interest�in�seeing�more�community�festivals�and�fairs.��

�


Residents�that�are�familiar�with�diabetic�issues�identified�the�following�resource�in�their�community�that�they�felt�improved�the�lack�of�community�services:�

� The�Bedford�Chamber�of�Commerce�is�a�strong�resource��


Residents� that� are� familiar� with� diabetic� issues� did� not� offer� suggestions� or� recommendations� to�improve�the�lack�of�community�services.��

�

LIMITED�ACCESS�TO�TRANSPORTATION:�

Residents�that�are� familiar�with�diabetic� issues� indicated�that� there� is� limited�access�to�transportation�due�to�the�removal�of�the�circular�and�a�reduction�in�available�bus�routes.��


� PERA� provides� transportation� to� elderly� and� disabled� residents� as� long� as� they� schedule� two�weeks�in�advance.��

� RTA�bus�routes�have�been�reduced�making�it�difficult�to�use�public�transportation.�� The�circular�bus�service�was�eliminated�making�public�transportation�less�convenient.�� There� are� no� shuttle� services� available� for� medical� appointments� in� some� communities� (i.e.�

Beachwood).��


Residents� that� are� familiar� with� diabetic� issues� identified� the� following� resources� in� their� community�that�they�felt�could�improve�access�to�transportation:�

� METRO�provides�discount�parking�through�their�Senior�Advantage�Program�� Some�residents�have�access�to�private�transportation�� METRO�provides�transportation�for�medical�appointments�to�residents�in�many�communities.�� PERA�provides�transportation�to�senior�and�disabled�residents�

�

��


Residents� that� are� familiar� with� diabetic� issues� did� not� offer� suggestions� or� recommendations� to�improve�access�to�transportation.��

�

�

GENERAL�FOCUS�GROUP�DISCUSSION�GUIDE��

I. GREETINGS�–�INTRODUCTION�BY�CONTACT�PERSON�

II.� GROUP�DISCUSSION�FORMAT�

�

A.��INTRODUCTION�

� Thanks� for� coming� here� today.� � My� name� is� ______,�we�are�helping� [name�of� community�hospital]�conduct�a�community�health�assessment.��

� Our�goal�is�that�everyone�here�will�feel�comfortable�speaking�openly�and�contributing�to�our�

discussion.��There�are�no�wrong�answers,�just�different�experiences�and�points�of�view.��So�please�feel�free�to�share�your�experiences�and�your�point�of�view,�even�if�it�is�different�from�what�others�have�said.�

�

� Your�comments�will�be�summarized�in�a�report,�but�nobody�here�will�be�identified�by�name,�and�no�comment�will�be�connected�to�any�individual,�so�you�can�be�sure�of�your�anonymity.�

�

� Because�we�are�taping�this�discussion�so�that�we�can�write�our�report,�it�is�important�for�everyone�to�speak�up�and�that�only�one�person�talks�at�a�time.�

�

� My�role�will�be�to�ask�questions�and�listen.��It�is�important�for�us�to�hear�from�all�of�you�because�you�all�have�different�and�valuable�experiences.��If�we�haven’t�heard�from�some�of�you,�don’t�be�surprised�if�I�call�on�you�to�share�something�about�your�experiences.�

�� Does�anyone�have�any�questions�before�we�begin?�

�

B.��EVERYONE�INTRODUCES�HIM�OR�HERSELF�

� I’d�like�to�start�by�going�around�the�table�and�have�everyone�introduce�themselves�and�how�long�you�have�lived�in�the�community.��

�

��

C.��FOCUS�GROUP�

1. What�is�a�healthy�community?��

2. Do�you�think�your�community�is�a�healthy�place�–�(Why?�Why�not?�Explain...)��

3.��“What�are�the�biggest�health�issues�or�concerns�in�your�community?�(Where�you�live)�

(Health�concerns�for�you,�for�your�family,� for�others� in�your�neighborhood)?”(Have�everyone�share� their� top�health� concerns.� �The� facilitation� team�will�make�a�quick� list�of�what�everyone�says�and�place�check�marks�next�to�repeats�to�get�a�quick�prioritized�list.)��

�

REPEAT�THESE�QUESTION��FOR�EACH�ITEM�THAT�CAME�UP�AS�A�TOP�CONCERN�(top�4�or�5)�

a. Why�do�you�think�_________________�is�a�problem�in�this�community?�b. What�are�the�resources�in�the�community�to�help�solve�this�problem?�c. What�ideas�do�you�have�about�to�solve�this�problem?�d. How�would�your�community�be�different�(better,�improved,�etc.)�if�this�issue�went�away?��

�

�Is�there�anything�we�haven’t�discussed�today�that�you�would�like�to�talk�about?�

�

Thank�You!!�

Provide�them�with�incentive�

�

�

��

APPENDIX E:

South Pointe Hospital Focus Group Summary -- Underinsured or Uninsured Residents Group

��

UNDERINSURED�OR�UNINSURED�RESIDENTS�FOCUS�GROUP�INPUT�

Community:�


INTRODUCTION:�

The� following� qualitative� data� were� gathered� during� a� discussion� group� conducted� with� a� target�population�of� residents� that� are�underinsured�or�uninsured� in� the�South� Pointe�Hospital� service� area.�The� target� population� was� defined� by� an� advisory� committee� of� South� Pointe� Hospital� executive�leadership.�South�Pointe�Hospital�is�a�213�bed�acute�care,�community�teaching�hospital�and�also�one�of�nine�Cleveland�Clinic� community�hospitals� in�Northeast� Ohio.� The� discussion� group�was� conducted� by�Tripp� Umbach� consultants� and� was� located� at� the� Harvard� Community� Center.� Each� participant� was�provided�an�incentive�of�twenty�five�dollars�for�participating.�Discussion�groups�were�conducted�using�a�discussion� guide� previously� developed� by� Tripp� Umbach� and� reviewed� by� the� South� Pointe� Hospital�executive� leadership� project� team.� The� purpose� of� this� discussion� group� was� to� identify� health� issues�and�concerns�affecting�residents�that�are�underinsured�or�uninsured�in�the�South�Pointe�Hospital�service�area�as�well�as�ways�to�address�those�concerns�for�this�specific�population.�


The�group�provided�many�recommendations�to�address�health�issues�and�concerns�for�residents�that�are�underinsured�or�uninsured�that�live�in�the�South�Pointe�Hospital�service�area.�Below�is�a�brief�summary�of�the�recommendations:�

� Provide�a�service�that�helps�underinsured/uninsured�residents�secure�medication:�South�Pointe�Hospital� should� provide� a� service� that� ensures� underinsured/uninsured� residents� are� able� to�secure� medications� they� are� prescribed.� There� are� many� programs� that� help� people� get� their�medication�when�they�cannot�afford�it�but�residents�are�not�aware�of�these�programs�and�often�have�difficulty�completing�the�required�paperwork.�Providing�a�service�to�help�residents�secure�medication� would� increase� the� likelihood� that� they� will� take� the� medications� they� are�prescribed.��

� Provide� incentives� for� healthy� behaviors:� South� Pointe� Hospital� should� collaborate� with� local�businesses�to�provide�residents� incentives�for�practicing�healthy�behaviors�such�as�weight� loss�and� physical� fitness� (e.g.� the� weight� loss� challenge� at� J.F.K.� recreational� center).� Incentivizing�such� behaviors� would� increase� the� likelihood� that� residents� would� practice� healthy� behaviors�resulting� in� a� healthier� community� in� which� residents� require� health� services� less� frequently.�Currently�there�are�few�incentives�for�residents�to�practice�healthy�behaviors.�

� �

��

�� Provide�mobile�dental�services:�Mobile�dental�services�would�provide�routine�dental�care�and�

prevention� education� to� underinsured/uninsured� residents� to� ensure� the� dental� needs� of�residents�are�met.� A� mobile�dental� service�would� improve� the� health�of� residents� and� reduce�dental� emergencies� among� underinsured/uninsured� residents.� Currently�underinsured/uninsured�residents�do�not�have�adequate�access�to�dental�care.��

� Increase� the� effectiveness� of� information� dissemination� in� the� community:� The� city� should�spend� more� money� ensuring� residents� have� access� to� information� by� identifying� the� most�effective� method� for� disseminating� information� in� the� specific� community� and� then�implementing�that�method�(e.g.�word�of�mouth,�flyers,�community�calendar��and�mail�inserts).�Increasing� residents’� access� to� information� would� increase� awareness� and� participation� in�events,� programs� and� services.� Currently� residents� are� not� receiving� relevant� up� to� date�information.��

� Provide� a� central� information� portal:� The� city� should� provide� a� central� access� point� where�available� events� programs� and� services� can� be� located� allowing� residents� to� access� this�information� when� they� need� and/or� want� to.�Providing�a� central� access� point� for� information�about� community� events,� programs� and� services� would� empower� residents� to� seek� out�necessary� information� and� increase� their� awareness� and� participation� in� available� events�programs�and�services.�Currently�information�is�not�centralized�and�residents�often�are�unaware�of�resources,�events,�program�and�services�available�in�the�community.��

� Provide� community� health� fairs� and� outreach� services:� South� Pointe� Hospital� should� provide�community�health� fairs�and�ongoing�outreach�services� to� increase�residents’�awareness�about�prevention,� programs� and� services� available� at� the� hospital� and� in� the� community.� Increasing�residents’� awareness� about� programs� and� services� the� hospital� offers� would� increase� their�participation�in�those�programs�and�services.�Increasing�residents’�awareness�about�prevention�would�increase�the�likelihood�residents�would�practice�prevention�and�improve�the�health�of�the�community.� Currently� residents� feel� there� are� not� adequate� prevention� services� available� in�their�community.��

� Residents� inform� one� another:� Residents� need� to� collaborate� with� one� another� and� begin�sharing� information�amongst�them�to�ensure�each�has�access�to�the�most�up�to�date�relevant�information�about�events,�programs�and�services�available�in�the�community.�Residents�sharing�information�with�one�another�would�increase�access�to�information�and�connect�residents�with�each� other� and� the� community.� Currently� residents� are� not� sharing� information� enough� for�everyone�to�remain�informed.��

� Hospitals�should�collaborate�with�churches�to�ensure�the�availability�of�healthy�food:�Hospitals�should�collaborate�with�local�churches�to�provide�fresh�healthy�food�to�residents�because�many�residents� are� using� this� service.� Increasing� the� availability� of� healthy� food� supports� the�nutritional� health� of� residents.� Improving� the� nutritional� health� of� residents� could� reduce� the�risk�of� lifestyle�diseases�such�as�diabetes.�Currently� residents� feel� there� is�not�enough�healthy�food�or�fresh�produce�available�in�their�community.��

��

� Begin� providing� prevention� education� to� families� early:� Hospitals� should� begin� teaching�mothers�and�families�about�healthy�nutrition�and�available�resources�after� the�birth�of�a�child�and�before�discharge.�Providing� this� type�of�prevention�education�would�empower� families� to�make� healthier� choices� for� themselves� and� their� children.� Empowering� families� to� make�healthier� choices� could� improve� the� health� of� the� community� overall� and� cause� residents� to�require�medical�services�less�frequently.�Currently�this�type�of�services�is�not�made�available�to�new�mothers.��

� Use�available� lots�for�farmers�markets:�The�city�should�begin�to�use�available�lots�for�farmers�markets� that� the� community� could� get� involved� in� allowing� residents� greater� access� to� fresh�produce.�Increasing�access�to�fresh�produce�would�improve�the�nutritional�health�of�residents.��

� Provide�more� educational� classes:� The� hospitals� should� collaborate� with� local� resources� (e.g.�the�food�bank)� to�provide�nutrition�education�classes�to�residents.�Nutrition�education�classes�would� increase� residents’� awareness� about� healthy� nutrition� which� could� improve� residents’�nutritional� health.� Improving� residents’� nutritional� health� could� improve� their� overall� health�causing�residents�to�require�medical�services�less�frequently.��Currently�residents�feel�there�are�not�enough�nutrition�education�classes�available�in�the�community.��

� Residents� should� get� more� involved� with� community� garden� clubs:� Increasing� resident�involvement� in� community� garden� clubs� would� increase� their� access� to� seasonally� fresh�produce.� Harvard� Community� Center� has� a� garden� club� with� twenty� garden� systems� that� are�available� for� resident� participation.� Residents’� involvement� in� community� garden� clubs� would�empower�residents�to�grow�and�harvest�their�own�fresh�produce�increasing�their�access�to�fresh�produce�and�improving�their�nutritional�health.�Currently�many�residents�are�not�involved�in�the�garden�clubs�at�Harvard�Community�Center.��

�


During�the�discussion�group�process,�residents�that�are�underinsured�or�uninsured�discussed�four�health�issues�and�concerns�in�their�community.�These�were:�

1. Limited�access�to�health�services��2. Lack�of�collaboration�and�information�dissemination�3. Limited�access�to�healthy�food�options�4. Lack�of�access�to�transportation��

LIMITED�ACCESS�TO�HEALTH�SERVICES:�

Residents�that�are�underinsured�or�uninsured�indicated�that�health�services�in�the�South�Pointe�Hospital�service�area� are� limited� in� the�areas�of�primary�and�preventive�medical� care,�mental�health� care,�and�dental�care�due�to�a�lack�of�insurance,�services,�awareness�and�financial�resources.�

� �

��


� Uninsured� emergency� medical� services� are� not� available� on� a� sliding� scale� fee� and� are� often�unaffordable.�

� Some� participants� would� prefer� to� see� a� medical� doctor� instead� of� a� physician’s� assistant� or�nurse�practitioner�causing�them�to�avoid�clinic�services.�

� Uninsured� medical� screenings� are� unaffordable� for� participants� resulting� in� a� lack� of�participation�in�prevention�services.�

� Participants�felt�there�is�a�lack�of�events�that�promote�health�and�prevention�education�such�as�health�fairs.��

� Programs�that�incentivize�healthy�behavior�(i.e.�weight�loss�and�fitness)�are�not�readily�available�for�underinsured/uninsured�residents.�

� Participants�felt�they�do�not�obtain�all�the�information�they�need�during�a�medical�appointment�due�to�being�rushed�and�doctors�having�an�undesirable�“bedside�manner”.�

� Underinsured/uninsured� residents� are� unaware� of� available� affordable� mental� health� services�due� to�a� lack�of�outreach� to� this� specific�population�and� facility� closures� resulting� in� a� lack� of�access�to�mental�health�care�including�psychotropic�medications�and�therapeutic�services.�

� Dental�services�are�not�readily�available�to�underinsured/uninsured�residents.��


Residents�that�are�underinsured�or�uninsured�identified�the�following�resources�in�their�community�that�they�felt�could�help�increase�their�access�to�health�services:�

� METRO� Hospital� and� NEON� South� charge� underinsured/uninsured� income� based� rates� for�medical�services��

� The�Healthy�Growth�Program�refers�mothers�for�needed�services�� Medical�residents�provide�good�health�care�services�� Nurse�practitioners�can�see�patients�quicker�than�doctors�sometimes�� Some�doctors�take�time�with�their�patients�

�


Residents� that� are� underinsured� or� uninsured� offered� the� following� as� possible� solutions� to� improve�their�access�to�health�services�in�their�community:�

� Provide�a�service�that�helps�underinsured/uninsured�residents�secure�medication:�South�Pointe�Hospital� should� provide� a� service� that� ensures� underinsured/uninsured� residents� are� able� to�secure� medications� they� are� prescribed.� There� are� many� programs� that� help� people� get� their�medication�when�they�cannot�afford�it�but�residents�are�not�aware�of�these�programs�and�often�have�difficulty�completing�the�required�paperwork.�Providing�a�service�to�help�residents�secure�medication� would� increase� the� likelihood� that� they� will� take� the� medications� they� are�prescribed.��

� Provide� incentives� for� healthy� behaviors:� South� Pointe� Hospital� should� collaborate� with� local�businesses�to�provide�residents� incentives�for�practicing�healthy�behaviors�such�as�weight� loss�

��

and� physical� fitness� (e.g.� the� weight� loss� challenge� at� J.F.K.� recreational� center).� Incentivizing�such� behaviors� would� increase� the� likelihood� that� residents� would� practice� healthy� behaviors�resulting�in�a�healthier�community�in�which�residents�require�health�services�less�frequently.��

� �Provide�mobile�dental�services:�Mobile�dental�services�would�provide�routine�dental�care�and�prevention� education� to� underinsured/uninsured� residents� to� ensure� the� dental� needs� of�residents�are�met.� A� mobile�dental� service�would� improve� the� health�of� residents� and� reduce�dental�emergencies�among�underinsured/uninsured�residents.�

�

LACK�OF�COLLABORATION�AND�INFORMATION�DISSEMINATION:�

Residents� that� are� underinsured� or� uninsured� indicated� that� there� is� a� lack� of� collaboration� and�information� dissemination� causing� a� lack� of� awareness� about� and� participation� in� available� programs�and�services.�


� Events,� programs� and� services� are� not� widely� publicized� causing� a� lack� of� participation� (i.e.�health�fairs,�United�Way’s�#211�referral�service,�free�services).�

� Many� residents� do� not� have� access� to� information� outlets� being� used� to� disseminate�information�(i.e.�Channel�21�requires�cable�service,�email�requires�internet�service).��

� Hospitals�do�not� reach�out� to� the� community� to�provide�community� specific� information� (e.g.�flyers,�pamphlets,�etc)�

� Residents� in� the�community�are�not� informing�each�other�enough�and�the�primary�method�of�information�dissemination�in�the�community�is�word�of�mouth.�

� Residents�are�not�taking�responsibility�for�finding�out�needed�information.�� PTA� used� to� provide� collaboration� between� schools� and� parents� but� they� are� not� as� effective�

today.�� Residents�are�overwhelmed�with�disorganized�duplicated� information�that� they� find� irrelevant�

to�their�needs.��


Residents�that�are�underinsured�or�uninsured�identified�the�following�resources�in�their�community�that�they�felt�could�improve�collaboration�and�information�dissemination:�

� Churches�disseminate�information�� United�Way’s�#211�referral�service�provides�relevant�information�and�referrals�� Residents� that� have� access� to� cable� service� are� able� to� get� information� about� free� events,�

programs�and�services�� WKYC�provides�information�about�FREE�events�� Many�organizations�disseminate�information�via�email�and�the�internet��

�

� �

��


Residents� that� are� underinsured� or� uninsured� offered� the� following� as� possible� solutions� to� improve�collaboration�and�information�dissemination�in�their�community:��

� Increase� the� effectiveness� of� information� dissemination� in� the� community:� The� city� should�spend� more� money� ensuring� residents� have� access� to� information� by� identifying� the� most�effective� method� for� disseminating� information� in� the� specific� community� and� then�implementing�that�method�(e.g.�word�of�mouth,�flyers,�community�calendar��and�mail�inserts).�Increasing� residents’� access� to� information� would� increase� awareness� and� participation� in�events,�programs�and�services.��

� Provide� a� central� information� portal:� The� city� should� provide� a� central� access� point� where�available� events� programs� and� services� can� be� located� allowing� residents� to� access� this�information� when� they� need� and/or� want� to.� Providing�a� central�access�point� for� information�about� community� events,� programs� and� services� would� empower� residents� to� seek� out�necessary� information� and� increase� their� awareness� and� participation� in� available� events�programs�and�services.��

� Provide� community� health� fairs� and� outreach� services:� South� Pointe� Hospital� should� provide�community�health� fairs�and�ongoing�outreach�services� to� increase�residents’�awareness�about�prevention,� programs� and� services� available� at� the� hospital� and� in� the� community.� Increasing�residents’� awareness� about� programs� and� services� the� hospital� offers� would� increase� their�participation�in�those�programs�and�services.�Increasing�residents’�awareness�about�prevention�would�increase�the�likelihood�residents�would�practice�prevention�and�improve�the�health�of�the�community.��

� Residents� inform� one� another:� Residents� need� to� collaborate� with� one� another� and� begin�sharing� information� amongst� themselves� to� ensure� each� has� access� to� the� most� up� to� date�relevant�information�about�events,�programs�and�services�available�in�the�community.�Residents�sharing� information� with� one� another� would� increase� access� to� information� and� connect�residents�with�each�other�and�the�community.��

�

LIMITED�ACCESS�TO�HEALTHY�FOOD�OPTIONS:�

Residents�that�are�underinsured�or�uninsured�indicated�there�is�limited�access�to�healthy�food�options�in�their� communities� due� to� a� lack� of� transportation,� the� cost� of� healthy� food� and� restrictions� on� food�pantry�services.�


� Participants�felt�there�are�not�enough�places�that�provide�fresh�produce.�� There� is� a� farmers� market� but� it� is� difficult� for� residents� to� get� there� due� to� a� lack� of�

transportation.�� Many�residents�can�not�afford�the�higher�cost�of�healthy�food.�

��

� Food�pantry�services�are�available�but�some�food�pantries�will�not�provide�food�to�an�individual�who�lives�outside�of�the�appropriate�zip�code(s).��

� Corner�stores�are�readily�available�and�they�sell�food�but�it�is�not�fresh�or�healthy.�� WIC�offices�provide�mothers�with�fresh�food�options�and�exclude�all�other�residents.�

�


Residents�that�are�underinsured�or�uninsured�identified�the�following�resources�in�their�community�that�they�felt�increases�access�to�healthy�food:�

� Food�pantries�and�many� churches�are�providing� free� food� to� residents� some�of�which� is� fresh�food�

� WIC�offices�provide�mothers�with�fresh�food�options�� Harvard�Community�Center�garden�club�has�twenty�garden�systems��

�


Residents� that� are� underinsured� or� uninsured� offered� the� following� as� possible� solutions� to� increase�access�to�healthy�food�in�their�community:��

� Hospitals�should�collaborate�with�churches�to�ensure�the�availability�of�healthy�food:�Hospitals�should�collaborate�with�local�churches�to�provide�fresh�healthy�food�to�residents�because�many�residents� are� using� this� service.� Increasing� the� availability� of� healthy� food� supports� the�nutritional� health� of� residents.� Improving� the� nutritional� health� of� residents� could� reduce� the�risk�of�lifestyle�diseases�such�as�diabetes.��

� Begin� providing� prevention� education� to� families� early:� Hospitals� should� begin� teaching�mothers�and�families�about�healthy�nutrition�and�available�resources�after� the�birth�of�a�child�and�before�discharge.�Providing� this� type�of�prevention�education�would�empower� families� to�make� healthier� choices� for� themselves� and� their� children.� Empowering� families� to� make�healthier� choices� could� improve� the� health� of� the� community� overall� and� cause� residents� to�require�medical�services�less�frequently.��

� Use�available� lots�for�farmers�markets:�The�city�should�begin�to�use�available�lots�for�farmers�markets� that� the� community� could� get� involved� in� allowing� residents� greater� access� to� fresh�produce.�Increasing�access�to�fresh�produce�would�improve�the�nutritional�health�of�residents.��

� Provide�more� educational� classes:� The� hospitals� should� collaborate� with� local� resources� (e.g.�the�food�bank)� to�provide�nutrition�education�classes�to�residents.�Nutrition�education�classes�would� increase� residents’� awareness� about� healthy� nutrition� which� could� improve� residents’�nutritional� health.� Improving� residents’� nutritional� health� could� improve� their� overall� health�causing�residents�to�require�medical�services�less�frequently.��

� Residents� should� get� more� involved� with� community� garden� clubs:� Increasing� resident�involvement� in� community� garden� clubs� would� increase� their� access� to� seasonally� fresh�produce.� Harvard� Community� Center� has� a� garden� club� with� twenty� garden� systems� that� are�

��

available� for� resident� participation.� Residents’� involvement� in� community� garden� clubs� would�empower�residents�to�grow�and�harvest�their�own�fresh�produce�increasing�their�access�to�fresh�produce�and�improving�their�nutritional�health.��

LACK�OF�ACCESS�TO�TRANSPORTATION:�

Residents� that� are� underinsured� or� uninsured� indicated� that� there� is� limited� access� to� transportation�due�to�the�removal�of�the�circular�and�a�restricted�medical�transportation�limiting�residents’�access�to�medical�care�and�healthy�food�options.��


� There� are� resources� that� will� provide� transportation� for� medical� appointments� (i.e.� Provide� a�Ride)�but�the�service�requires�medical�insurance,�a�doctors�signature�and�is�restricted�to�only�the�patient�seeking�medical�care.��

� The�circular�bus�services�was�eliminated�which�provided�residents�convenient�transportation�for�medical�appointments�and�shopping.��

�


Residents�that�are�underinsured�or�uninsured�identified�the�following�resource�in�their�community�that�they�felt�improved�access�to�transportation:�

� METRO�and�NEON�South�provide�transportation�for�medical�appointments��


Residents�that�are�underinsured�or�uninsured�did�not�offer�suggestions�or�recommendations�to�improve�access�to�transportation.��

�

�

��

APPENDIX F:

South Pointe Hospital Focus Group Summary -- Senior Residents Group

��

SENIOR�RESIDENTS�FOCUS�GROUP�INPUT�

Community:�


INTRODUCTION:�

The� following� qualitative� data� were� gathered� during� a� discussion� group� conducted� with� a� target�population� of� senior� residents� in� the� South� Pointe� Hospital� service� area.� The� target� population� was�defined�by�an�advisory�committee�of�South�Pointe�Hospital�executive�leadership.�South�Pointe�Hospital�is�a�213�bed�acute�care,�community�teaching�hospital�and�also�one�of�nine�Cleveland�Clinic�community�hospitals�in�Northeast�Ohio.�The�discussion�group�was�conducted�by�Tripp�Umbach�consultants�and�was�located� at� the� Bedford� Heights� Community� Center.� Each� participant� was� provided� an� incentive� of�twenty�five� dollars� for� participating.� Discussion� groups� were� conducted� using� a� discussion� guide�previously� created� by� Tripp� Umbach� and� reviewed� by� the� South� Pointe� Hospital� executive� leadership�project�team.�The�purpose�of�this�discussion�group�was�to�identify�health�issues�and�concerns�affecting�senior�residents�in�the�South�Pointe�Hospital�service�area�as�well�as�ways�to�address�those�concerns�for�this�specific�population.�


The�group�provided�many�recommendations�to�address�health�issues�and�concerns�for�senior�residents�that�live�in�the�South�Pointe�Hospital�service�area.�Below�is�a�brief�summary�of�the�recommendations:�

� Provide� in�home� care� as� part� of� discharge� planning:� Hospitals� should� provide� in�home� care�following� any� surgery� and/or� an� inpatient� stay� to� ensure� seniors� understand� discharge�instructions,� are� informed� and� able� to� recover� fully� at� home.� Providing� in�home� care� would�decrease�seniors’� risk�after�surgery�and� increase� their�comfort�with�and�access� to� information�about� their� own� health� status.� Providing� in�home� care� could� also� reduce� the� likelihood� that�seniors�will�return�to�the�emergency�room�unnecessarily.�Currently�many�seniors�do�not�speak�to�the�doctor�after�a�procedure�and�they�feel�the�discharge�instructions�are�unclear.��

� Provide�additional�staff� to�keep�patients�up�to�date:�Hospitals�and�clinics�should�allot�staff�to�inform�patients�about�what�is�happening�during�lengthy�exam�room�waiting�periods.�Seniors�feel�they� would� experience� less� stress� and/or� anxiety� during� medical� appointments� if� they� were�aware�of�what�was�causing�the�wait�time.�Currently�seniors�can�wait� in�an�exam�room�up�to�2�hours�before�they�see�a�doctor.��

� Provide�a�central�access�portal�for�information:�A�central�access�portal�for�community�specific�information�would�empower�seniors�to�access�relevant�information�as�they�need�it.�Empowering�seniors� with� the� ability� to� locate� relevant� information� when� they� need� it� would� increase�awareness�of�and�participation�in�resources,�events,�programs�and�services�as�well�as�reduce�the�overwhelming� feeling� seniors� have� about� the� amount� of� information� they� receive.� Currently�seniors�feel�overwhelmed�by�the�volume�of�information�they�receive.��

��

�

� Provide�a�delivery�services�to�meet�basic�senior�needs:�A�delivery�services�should�be�available�for�a�small�fee�to�meet�seniors’�basic�needs�(i.e.�grocery�shopping).�The�delivery�services�could�provide�an�aide�that�seniors�could�contact�for�help�(e.g.�request�for�grocery�pickup�and�delivery)�then� the� aide� would� complete� the� requests� on� a� fee� for� service� basis.� Providing� an� aide� to�seniors� in� the� community� would� reduce� the� daily� necessity� for� transportation� and� ensure�seniors’�day�to�day�needs�are�met.�Currently�seniors�do�not�feel�they�have�adequate�information�upon�discharge�from�the�hospital�and�often�they�end�up�back�in�the�emergency�room�as�a�result.�

�


During�the�discussion�group�process,�senior�residents�discussed�four�health�issues�and�concerns�in�their�community.�These�were:�

1. Inadequate�service�provision�2. Ineffective�information�dissemination�3. Lack�of�safety�4. Lack�of�transportation�and�parking��

INADEQUATE�SERVICE�PROVISION:�

Senior� residents� indicated� that�while� they�have�access� to�health� resources� the�provision�of� services� is�poor�due�to�scheduling�difficulties,�lengthy�exam�room�waiting�periods,�inadequate�communication�from�their� doctors,� poor� bedside� manner� and� a� lack� of� support� groups.� Seniors� felt� that� they� did� not� have�enough� information� about� their� individual� health� status� causing� them� to� feel� uncomfortable,�uninformed�and�scared.��


� It� is� difficult� to� schedule� routine� medical� appointments� because� the� phone� process� is� lengthy�and�communication�is�done�via�email�instead�of�talking�to�a�person.��

� It�is�difficult�to�see�a�doctor�the�same�day�because�often�seniors�are�told�to�go�to�the�emergency�room�instead.��

� Seniors� felt� that� they� do� not� receive� adequate� information� about� their� health� status� due� to�lengthy� exam� room� waiting� periods� and� little� face� time� with� doctors� causing� seniors� to� feel�uncomfortable,�uninformed�and�scared.�

� Seniors� were� dissatisfied� with� the� bedside� manner� of� many� doctors� due� to� a� lack� of�communication�before�and�after� surgeries,�a� lack�of�personal�connection�and� little� to�no� time�allotted� for� questions� and� answers.� Seniors� indicated� this� was� a� major� service� provision� issue�among�surgeons�and�specialist�at�Cleveland�Clinic�Hospitals.�

� There� is� often� a� lack� of� consistency� in� the� staff� seniors� see� during� each� visit� resulting� in� the�necessity�to�answer�the�same�questions�each�time.�

� Some� participants� did� not� feel� comfortable� speaking� to� physician’s� assistants� or� nurse�practitioners�because�they�wanted�to�see�a�medical�doctor.��

��

� Follow�up� from� discharge� is� often� inadequate� due� to� a� lack� of� information� on� discharge�instructions�and�an�absence�of�communication�with�the�doctor�causing�seniors�to�return�to�the�emergency�room�at�times�when�it�may�be�unnecessary.�

� Hospital�bills�list�a�doctor’s�name�and�no�explanation�of�the�service�provided�causing�them�to�be�unclear.��

� There�is�a�lack�of�support�groups�provided�at�South�Pointe�Hospital�and�in�the�community.��


Senior� residents� identified� the� following� resources� in� their� community� that� they� felt� helps� improve�service�provision:�

� Primary�care�services�are�good�� HMO�can�secure�a�same�day�medical�appointment�� Urgent�Care�Clinics�are�available�� Nurse�on�Call�provides�assessment�and�referral�services�over�the�phone�� Bedford�Hospital�has�provided�support�groups�� The�newspaper�advertises�support�groups�available�in�the�community�(i.e.�church�groups)�� Health�Wise�Connections�provides�information�about�support�groups�every�three�months�� Cleveland�Clinic�has�a�good�EMR�system�� Advice�nurses�are�available�through�Cleveland�Clinic�to�give�general�information�and�advice�

�


Senior� residents� offered� the� following� as� possible� solutions� to� improve� service� provision� in� their�community:�

� Provide� in�home� care� as� part� of� discharge� planning:� Hospitals� should� provide� in�home� care�following�any�surgery�and/or�inpatient�stay�to�ensure�seniors�understand�discharge�instructions�and� are� properly� to� recover� at� home.� Providing� in�home� care� would� decrease� seniors’� post�surgery�health�risks�and�increase�their�comfort�levels.�Providing�in�home�care�could�also�reduce�the�likelihood�that�seniors�will�return�to�the�emergency�room�unnecessarily.��

� Provide�additional�staff� to�keep�patients�up�to�date:�Hospitals�and�clinics�should�allot�staff�to�inform�patients�about�what�is�happening�during�lengthy�exam�room�waiting�periods.�Seniors�feel�they� would� experience� less� stress� and/or� anxiety� during� medical� appointments� if� they� were�aware�of�what�was�causing�the�wait�time.��

�

� �

��

INEFFECTIVE�INFORMATION�DISSEMINATION:�

Senior�residents�indicated�that�the�primary�methods�of�disseminating�information�in�their�communities�are� largely� ineffective� due� to� a� lack� of� awareness,� disorganized� and� duplicated� information,� not� using�technology,�and�newspaper�print�being� too�small.�The� ineffective�dissemination�of� information�causes�seniors�to�be�unaware,�misinformed�and�confused.�


� Many�seniors�are�not�aware�of�available�resources,�events,�programs�and�services�(i.e.�the�older�adults�resource�guide,�advice�nurse�service,� location�of�urgent�care�clinics,�etc.)�causing�a� lack�participation�in�and�disuse�of�available�resources.��

� Seniors�felt�overwhelmed�by�the�volume�of�information�they�receive�that�is�often�disorganized�and�duplicated.��

� Many�seniors�do�not�access�information�via�the�internet�due�to�a�fear�of�technology�and�a�lack�of�interest�and/or�understanding.��

� Newspapers�are�the�preferred�method�among�many�seniors�for�accessing� information�and�the�print�is�often�too�small�for�seniors�to�read�comfortably.�

�


Senior�residents�identified�the�following�resources�in�their�community�that�they�felt�could�improve�the�effectiveness�of�information�dissemination:�

� Older�Adults�Resource�Guide�is�available�for�county�specific�information�in�Ohio�� Many�senior�centers�offer�coordinators�to�provide�information�on�available�resources,�programs�

and�services.�� Many�50+�clubs�offer�informational�speakers�and�pamphlets�that�address�preventive�care�� South�Pointe�Hospital�offers�classes�and�informational�material�(i.e.�Health�Wise�connections)�� Many�insurance�companies�mail�out�health�information�� Many� organizations� offer� technology� classes� (i.e.� the� high� school,� Light� of� Hearts� Villa,� the�

library,�and�the�community�center)�though�it�is�difficult�to�get�on�the�schedule�� Many�seniors�read�the�newspaper�for�information�

�


Senior�residents�offered�the�following�as�possible�solutions�to�improve�the�effectiveness�of�information�dissemination�in�their�community:��

� Provide�a�central�access�portal�for�information:�A�central�access�portal�for�community�specific�information�would�empower�seniors�to�access�relevant�information�as�they�need�it.�Empowering�seniors� with� the� ability� to� locate� relevant� information� when� they� need� it� would� increase�awareness�of�and�participation�in�resources,�events,�programs�and�services�as�well�as�reduce�the�overwhelming�feeling�seniors�have�about�the�amount�of�information�they�receive.�

�

��

LACK�OF�SAFETY:�

Senior� residents� indicated� that� there� is� a� lack� of� safety� due� to� an� absence� of� street� lights� and� young�residents� causing� trouble� resulting� in� some� seniors� not� feeling� safe� in� their� communities,� particularly�after�dark.��


� There�are�not�enough�street�lights�in�the�community�causing�the�streets�to�be�too�dark�at�night.�� Some�seniors�do�not�feel�safe�in�their�community�after�dark.�� Seniors�believe�there�are�a�lot�of�young�children�causing�trouble�in�their�communities.��

�Mitigating�Resources:�

Senior�residents�did�not�identify�resources�in�their�community�that�could�increase�safety.�


Senior�residents�did�not�offer�suggestions�or�recommendations�to�increase�safety�in�their�community.��

LACK�OF�TRANSPORTATION�AND�PARKING:�

Senior�residents�indicated�there�is�a�lack�of�transportation�and�insufficient�parking�due�to�cumbersome�scheduling�requirements,�inconvenient�schedules,�the�lengthy�distance�to�bus�stops,�and�the�absence�of�sidewalks.�The�lack�of�transportation�and�insufficient�parking�reduces�mobility�and�limits�seniors’�access�to�primary�and�preventative�health�care.�


� Some�seniors�avoid�seeking�medical�care�at�facilities�that�do�not�offer�adequate�parking�and/or�have�expensive�parking�fees�(i.e.�Mary�Mount�Hospital�and�Cleveland�Clinic�Hospitals).��

� Transportation� provided� by� the� county� to� senior� and� disabled� residents� (i.e.� CRT� service)� is�inconvenient�and�cumbersome�requiring�a�week�advance�scheduling,�inconvenient�pick�up�and�drop� off� times.� This� can� add� up� to� four� to� six� hours� to� the� time� required� to� attend� medical�appointments.��

� Transportation�provided�by�RTA�to�senior�and�disabled�residents�(i.e.�PERA)�has�a�cumbersome�enrollment�process,�is�not�as�handicap�accessible�and�has�similar�issues�with�transportation�time�as�the�CRT�service.�

� The�only� public� transportation�available� is� the�RTA�bus� service�which� requires� seniors� to�walk�long�distances�on�streets�without�sidewalks�to�get�to�bus�stops.�

� Many�seniors�do�not�drive�or�have�access�to�private�transportation.��


Senior�residents�identified�the�following�resources�in�their�community�that�they�felt�increase�access�to�transportation�and�parking:�

��

� The� city� provides� a� van/bus� to� transport� seniors� with� in� a� seven� mile� radius� which� requires�twenty�four�hours�advanced�notice�

� PERA�and�CRT�services�are�available�to�senior�and�disabled�residents�� Some�seniors�are�able�to�drive�or�have�access�to�private�transportation��

�


Senior� residents� offered� the� following� as� a� possible� solution� to� increase� access� to� transportation� and�parking�in�their�community:��

�� Provide�a�delivery�services�to�meet�basic�senior�needs:�A�delivery�services�should�be�available�

for�a�small�fee�to�meet�seniors’�basic�needs�(i.e.�grocery�shopping).�The�delivery�services�could�provide�an�aide�that�seniors�could�contact�for�help�(e.g.�request�for�grocery�pickup�and�delivery)�then� the� aide� would� complete� the� requests� on� a� fee� for� service� basis.� Providing� an� aide� to�seniors� in� the� community� would� reduce� the� daily� necessity� for� transportation� and� ensure�seniors’�day�to�day�needs�are�met.��

�

�

�

��

APPENDIX �:

�� Hospital� ��

��

Organization/Provider Counties Served Contact InformationInternet Information Population Served Services Provided A

FFO

RDA

BLE

HEA

LTH

CARE

FO

R U

ND

ERIN

SURE

D/U

NIN

SURE

D

ACC

ESS

TO A

FFO

RDA

BLE

HEA

LTH

CA

RE

AN

D M

EDIC

AL

SERV

ICE

PRO

VIS

ION

Prim

ary

Care

Prev

enti

ve C

are

COM

MU

NIT

Y A

WA

REN

ESS

AN

D

COH

ESIV

ENES

S

Colla

bora

tion

Out

reac

h /

Prev

enti

on E

duca

tion

Dis

sem

inat

ion

of In

form

atio

n

INFR

AST

RUCT

URE

Tran

spor

tati

on

Nut

riti

on E

duca

tion

Aff

orda

ble

hea

lthy

food

cho

ices

Park

s an

d Re

crea

tion

Hou

sing

211 / FIRST CALL FOR HELP �� "��*�=��*�@ ��XZ��\��^��X�```�{`��

��|�}��~�� @}}��{��}��~��{��{~��{��"��}��~�*��{��*��~��}��~��"��{��}��{��}��}��*��{��*��~��~��}��{~��

* X X

211 / FIRST CALL FOR HELP "{~~�� "�{��"��*�"{��*�@ ��X�X�Z\��

��|�}��~�� @}}��{��}��~��{��{~��"{~~��{��"��}��~�*��{��*��~��}��~��"��{��}��{��}��}��*��{��*��~��~��}��{~��

* X X

211 / FIRST CALL FOR HELP - CLEVELAND

�{�� {��*�@ ��X�Z��\��X�```��

��|�}��~�� @}}��{��}��~��{��{~��{��{��"��}��~�*��{��*��~��}��~��"��{��}��{��}��}��*��{��*��~��~��}��{~��

* X X

AKRON CHILDREN'S HOSPITAL PEDIATRICS – SOLON

�{�� "��=��"��*�@ ��X�Z��\�� |�}��~�� {�� ~��*��*��~��~��

* * X X * X X

AKRON CHILDREN'S HOSPITAL PEDIATRICS – TWINSBURG

"{~~�� `�=��*�"{��`��{��*�@ ��XZ��\��

��|�}��~�� {�� ~��*��*��~��~��

* * X X * X X

��}��{��"�{�� ~~{��}�{��}��~{��{��~��}��~~{��}��`��~�� ~~{��{��~��}��|="��Z"��\

��~��~��}��~~{��{��"�{�� {��{��}��*��}�� ~~{��{��`��}��"�{�� ~~{��Z��*��*��*��*��*��*��*��*��*��*��*��*��\�~��~~{��{��`��}��`��~��~~{��}��"�{�� Z��}��~~{�� ~��=��`��~~{��\

INVENTORY OF COMMUNITY RESOURCES AVAILABLE TO ADDRESS COMMUNITY HEALTH NEEDS IDENTIFIED IN THE SOUTH POINTE HOSPITAL CHNA

��


FFO

RDA

BLE

HEA

LTH

CARE

FO

R U

ND

ERIN

SURE

D/U

NIN

SURE

D

ACC

ESS

TO A

FFO

RDA

BLE

HEA

LTH

CA

RE

AN

D M

EDIC

AL

SERV

ICE

PRO

VIS

ION

Prim

ary

Care

Prev

enti

ve C

are

COM

MU

NIT

Y A

WA

REN

ESS

AN

D

COH

ESIV

ENES

S

Colla

bora

tion

Out

reac

h /

Prev

enti

on E

duca

tion

Dis

sem

inat

ion

of In

form

atio

n

INFR

AST

RUCT

URE

Tran

spor

tati

on

Nut

riti

on E

duca

tion

Aff

orda

ble

hea

lthy

food

cho

ices

Park

s an

d Re

crea

tion

Hou

sing

AKRON SUMMIT COMMUNITY ACTION, INC

"{~~�� "��*�@��XZ��\��X��```��{��~�

��|�}��~�� "{~~��{�� *��*��*��{��*��}��

* * X * X X * X

ALDERSGATE UNITED METHODIST CHURCH

�{�� `�� *�@ ��XZ��\��X�`��{~��

��|�}��~�� =��}��*� �� *��=��}��

��}��}��}��

* X

AURORA SENIOR ACTIVITY CENTER �� {��*�@��XZ��\��X�```��{��~

��|�}��~�� "�� *��*��*��}��`��*�~��`��*��*��{��*��{��{��`��`��*��^��{�� * X * X X * X X

BEACHWOOD COMMUNITY CENTER �{�� ~�{��{��`��*�@��X�Z��\��X��`��~

��|�}��~�� `��=��}��

��*��*��*��}��`��*�~��`��*��*��{��*��{��{��`��`��*��^��{��

* X * X X * X X X

BEACHWOOD FHC ��*��{��*�"{~~��*��{��

��=��`��*�@��XZ��\�� |�}��~�� {��`��~��*��{��~�� *��*�� * X X * X X X

BEDFORD HEIGHTS SENIOR SERVICES AND DISABILITIES DIV,

�{�� ~~��~��~~{��X��=��}�� *�@ ��X```��}��

��|�}��~�� "��`��

��*��*��*��}��`��*�~��`��*��*��{��*��{��{��`��`��*��^��{��

* * X X * X X * X X X

��


FFO

RDA

BLE

HEA

LTH

CARE

FO

R U

ND

ERIN

SURE

D/U

NIN

SURE

D

ACC

ESS

TO A

FFO

RDA

BLE

HEA

LTH

CA

RE

AN

D M

EDIC

AL

SERV

ICE

PRO

VIS

ION

Prim

ary

Care

Prev

enti

ve C

are

COM

MU

NIT

Y A

WA

REN

ESS

AN

D

COH

ESIV

ENES

S

Colla

bora

tion

Out

reac

h /

Prev

enti

on E

duca

tion

Dis

sem

inat

ion

of In

form

atio

n

INFR

AST

RUCT

URE

Tran

spor

tati

on

Nut

riti

on E

duca

tion

Aff

orda

ble

hea

lthy

food

cho

ices

Park

s an

d Re

crea

tion

Hou

sing

BRIDGE OF HOPE COMMUNITY CENTER

�{�� =��*�@ ��X�Z��\��X��

��|�}��~�� =��}��*��

��`��}��}�~��

* X

CENTER FOR COMMUNITY PROGRESS

��{�� {��{��*�"{��X��*��X�Z\��

��|�}��~�� ~~{��^��~��`��~��`��}��}}��*��{��{��{��*��*��~�� * X

CENTER OF HOPE & CHRISTIAN CUPBOARD

�� "��=��*�@ ��XZ��\��

��|�}��~�� =��}=��*�=��`��*��`�*��~��*��{��*��~��=��`�

��~��}��

* X

CITY OF MAPLE HEIGHTS �{�� =�� *�@ ��X�Z��\��X�```�~��~

��|�}��~�� =��}�� }��}��}��}��}�� {��*��{��*��`��{��`�~~��*��*��`��*��{��*��{��*��}��*��@}}��{��`�~~��*��*��*��}��*��*��*��*��

* X * X X * X X X

CITY OF SHAKER HEIGHTS �{�� =��"�� *�@ ��X�Z��\��X```��~

��|�}��~�� =��}�"�� ~~{��*��*��}��

* X X * X X * X X

CLEVELAND HEIGHTS OFFICE ON AGING

�{�� *�@ ��XZ��\��X�```��~

��|�}��~�� "�� *��}��`��*�~��`��*��*��{��*��{��~��~��{��`��`��*��^��{��

* * X X * X X * X X

CUYAHOGA COMMUNITY COLLEGE EASTERN CAMPUS

�{�� =��~��=�� *�@ ��XZ��\��

��|�}��~�� }��}��

��}��{��`��{��}��"��{��{��*��*��{��*��Z��{��{��~��\*��{��

* * X X * X X

CUYAHOGA COUNTY BOARD OF HEALTH

�{�� `��{��*��XZ��\��X��~��

��|�}��~�� |~~{��*��{��*��{��*�� * * X X * X X

CVS MINUTECLINIC ��*��{��*�"{~~��*��{��

��*��`��{��*��~��*�"��*��{��*�@ �X�```�~��{��~

��|�}��~�� ~��

* X X * X

��


FFO

RDA

BLE

HEA

LTH

CARE

FO

R U

ND

ERIN

SURE

D/U

NIN

SURE

D

ACC

ESS

TO A

FFO

RDA

BLE

HEA

LTH

CA

RE

AN

D M

EDIC

AL

SERV

ICE

PRO

VIS

ION

Prim

ary

Care

Prev

enti

ve C

are

COM

MU

NIT

Y A

WA

REN

ESS

AN

D

COH

ESIV

ENES

S

Colla

bora

tion

Out

reac

h /

Prev

enti

on E

duca

tion

Dis

sem

inat

ion

of In

form

atio

n

INFR

AST

RUCT

URE

Tran

spor

tati

on

Nut

riti

on E

duca

tion

Aff

orda

ble

hea

lthy

food

cho

ices

Park

s an

d Re

crea

tion

Hou

sing

DIABETES PARTNERSHIP OF CLEVELAND

�{��*��*��*��{��*��*�"{~~��

��"��=�� `��*�@ ��XZ��\��X��```��

��*��

��{��*��}��~��~��}��@}}��{��~��}��`��*��`��}��~��}��{�� * X * X X

DIABETES RESOURCE GUIDE �{��*��*��*��{��*��*�"{~~��

��"��=�� `��*�@ ��XZ��\��X��```��

��|�}��~�� *��

��{��{��}��^��{��*�@��`��*��}��~�� * X X

DROST FAMILY CENTER ��*��{��*��{��*��*�"{~~��

��~~��=��`��*�@ ��XZ��\��X�```��}��

��|�}��~�� ={��"��

��`��}��}��{��`��={��`��~��}��{��

* X * X X * X

EMERGENCY FOOD LINE "{~~�� "�{��"��*�"{��*�@��X�Z\��X�```��}��

��|�}��~�� =��}�"{~~��{�� }��}��}��{��}�~��}��~��{��}�}��}��~{��

* X

FAIRHILL PARTNERS �{�� =��*�@ ��X�Z��\��X```�}��

��|�}��~�� `��`��Z��*�}��~��*��*��\��}��~��{��}}��`��}��`��~��}��~��}��

* X X * X X X X

FAITH FILLED TRANSPORTATION �{�� "��~��=��*�@ ��X�Z��\��

* X

FAMILY AND COMMUNITY SERVICES, INC

�� @��`��"��*�"{��=��*�@ ��XZ��\��X�```��}�~��

��|�}��~�� {�� *� ��~��*��*�"��*��*� ��{��*�~��*�=�}��*�"��*�"��*�¡�{��~��{��

* * X * X X X * X X

FIRST CHOICE HOME HEALTH CARE SERVICES

�{��*��*��{��*��*��

��"��*�@ ��X�Z��\��X```�}��~

��|�}��~�� ~��~��

* X

GREATER CLEVELAND REGIONAL TRANSIT AUTHORITY

�{��{��`��{��

��"��*�@ ��XZ��\��X�```��~

��|�}��~�� {��~�`��{�*��^��{��`��^��

* X

GUIDE TO FREE OR AFFORDABLE HEALTH CARE FOR CHILDREN, TEENS AND ADULTS

�{�� }��=�� *�@ ��XZ��\��X��~��~��{��{��{�

��|�}��~�� {��`��}��{��{��{��~��~��`��}��}}��"��

* * X X X

HARVARD COMMUNITY SERVICES CENTER COMMUNITY NETWORKING

�{�� *�@ ��X�Z��\��X��

��|�}��~�� `��*��{��*��{��*��{��~~{��{��}}��

* X X X * X X X X

��


FFO

RDA

BLE

HEA

LTH

CARE

FO

R U

ND

ERIN

SURE

D/U

NIN

SURE

D

ACC

ESS

TO A

FFO

RDA

BLE

HEA

LTH

CA

RE

AN

D M

EDIC

AL

SERV

ICE

PRO

VIS

ION

Prim

ary

Care

Prev

enti

ve C

are

COM

MU

NIT

Y A

WA

REN

ESS

AN

D

COH

ESIV

ENES

S

Colla

bora

tion

Out

reac

h /

Prev

enti

on E

duca

tion

Dis

sem

inat

ion

of In

form

atio

n

INFR

AST

RUCT

URE

Tran

spor

tati

on

Nut

riti

on E

duca

tion

Aff

orda

ble

hea

lthy

food

cho

ices

Park

s an

d Re

crea

tion

Hou

sing

HEBREW SHELTER HOME - HOMELESS SHELTER

�{�� `��*�@ �� |�}��~�� }��`��~��~��}��"��~��~��}��{��~��~��"��{��{��}��

* X X

KENT SOCIAL SERVICES �� "��"��¢��*�@ ��X�Z��\�� |�}��~�� =��}�¢��*��`��

��~��}�� * X

LAKE COUNTY FREE CLINIC ��*��{��*��{��*��}��{��{��

��"�"��"��=~��*�@ ��X�Z��\��X�```��}��

��|�}��~�� {�� ~��}��~��~��@}}��~��~��}��{��*��*��*��{��}��`��*��*��*�� }��~��{��`��{��}��`��{��{��

* * X X * X X

LAKE WEST HOSPITAL ��*��{��*�"{~~��*��{��

��{��{��{��*�@��XZ��\��

��|�}��~�� {��`��~��*��~��~��*�`�~��*��*�� * X X * X

LEE-SEVILLE-MILES HUNGER CENTER �{�� *�@ ��X�Z��\��X```��{��`��

��|�}��~�� =��}��*��

��{��}��Z��}��~��{��~��\��}�~��@��*��}��~{�� ~��

* X

LHS TYLER URGENT CARE CLINIC �� *�@��X�Z��\�� |�}��~�� }��~��}��~��

* X X * X

LIGHT OF HEARTS VILLA �{�� "��}��*�@ ��X�Z��\�� |�}��~�� "��}��}��*��}�� *�� *��"��~��

��~��{��}�}�� * X

MAYFIELD CITY SCHOOL DISTRICT �{�� }��£��*�@ ��X�Z��\��X�```�~��}��

��|�}��~�� =��Z��~��\

��`��}��~��}��{��}��@}}��{��*��{��~��*��}��*��{��}��~��~��*��~�{��*��*��*�}��*��*��*��`��*�~��*��*�}��{��*��*��}��}��*��*��

* X X

MAYFIELD HEIGHTS DEPARTMENT OF HUMAN SERVICES

�{�� }��=��}�� *�@��XZ��\��

��|�}��~�� "�� *�"��`��{��*�

* X X * X X

MENTOR CAMPUS �� {��*�@��XZ��\��

��|�}��~�� {��~��}��`��~��~�� * X X * X X

METRO HEALTH BUCKEYE HEALTH CENTER

�{�� *�@ ��XZ��\��

��|�}��~�� ~�� ~��`��*��{��{��

* * X X * X X

��


FFO

RDA

BLE

HEA

LTH

CARE

FO

R U

ND

ERIN

SURE

D/U

NIN

SURE

D

ACC

ESS

TO A

FFO

RDA

BLE

HEA

LTH

CA

RE

AN

D M

EDIC

AL

SERV

ICE

PRO

VIS

ION

Prim

ary

Care

Prev

enti

ve C

are

COM

MU

NIT

Y A

WA

REN

ESS

AN

D

COH

ESIV

ENES

S

Colla

bora

tion

Out

reac

h /

Prev

enti

on E

duca

tion

Dis

sem

inat

ion

of In

form

atio

n

INFR

AST

RUCT

URE

Tran

spor

tati

on

Nut

riti

on E

duca

tion

Aff

orda

ble

hea

lthy

food

cho

ices

Park

s an

d Re

crea

tion

Hou

sing

METROHEALTH BEACHWOOD HEALTH CENTER

�{�� *�"{��{��`��*�@ ��

��|�}��~�� ~��*��~��~��}��{��

* * X X * X X

MILES PARK CORPS COMMUNITY CENTER

�{�� "��*�@ ��X�Z��\�� {��}��}��*�"��*��*�� * X X * X X X X

MONTEFIORE �{�� @��`��`��*�@ ��XZ��\��X�```�~��}��

��|�}��~�� "�� ~��~��}��}��{��"��{��*��~��*��~��*��~��*��{��*��*��{��{��*��~�~��

* * X X * X X * X

NEW CLEVELAND FOOD BASKET �{�� *�@ ��X�Z��\�� |�}��~�� {�� ~��}��

* X

OAKWOOD GOLDEN AGE CENTER �{�� `��{��@��`��*�@ ��XZ��\��X```��@��`��~

��|�}��~�� "�� *��*��*��}��`��*�~��`��*��*��{��*��{��{��`��`��*��^��{��

* X X * X X * X X

OHIO STATE UNIVERSITY EXTENSION - CUYAHOGA COUNTY

�{�� *�@ ��X�Z��\��X```��{��{��{

��|�}��~�� }��}��{��{��{��}��}�� * X

PLANET MEDICAL TRANSPORTATION �{��*��{��

��@��^�� *�@ ��X�Z��\��

��|�}��~�� *��Z}��}��\ * X

PLANNED PARENTHOOD OF NORTHEAST OHIO-BEDFORD CENTER

�{�� =��=��}��*�@ ��X�Z��\��X```��

��|�}��~�� =��{��

* * X X * X X

��


FFO

RDA

BLE

HEA

LTH

CARE

FO

R U

ND

ERIN

SURE

D/U

NIN

SURE

D

ACC

ESS

TO A

FFO

RDA

BLE

HEA

LTH

CA

RE

AN

D M

EDIC

AL

SERV

ICE

PRO

VIS

ION

Prim

ary

Care

Prev

enti

ve C

are

COM

MU

NIT

Y A

WA

REN

ESS

AN

D

COH

ESIV

ENES

S

Colla

bora

tion

Out

reac

h /

Prev

enti

on E

duca

tion

Dis

sem

inat

ion

of In

form

atio

n

INFR

AST

RUCT

URE

Tran

spor

tati

on

Nut

riti

on E

duca

tion

Aff

orda

ble

hea

lthy

food

cho

ices

Park

s an

d Re

crea

tion

Hou

sing

PLANNED PARENTHOOD OF NORTHEAST OHIO-SOLON EXPRESS CENTER

�{�� =��"��"��*�@ ��X```��

��|�}��~�� =��{��

* * X X * X X

PORTAGE COUNTY HEALTH DISTRICT �� "��"��*��*��{��~��=��*�@��X�Z��\��X```��{��~��~��

��|�}��~�� }��{��

��}��~~{��*��{��{��*�|~~{��*�=��~��~��*��}�"��{��~*� ��{��*� ��=��=��{��~�*� ��}��*�� ^��~�*��`�*��~��*��=��

* * X X * X X

RESOURCE GUIDE FOR OLDER ADULTS AND THEIR FAMILIES

�{��*��{��*��*��*��

��{��"��*�@ ��XZ��\��X�```��

��|�}��~�� "�� =��{��{��}��@��{��|��{��*��}��@��{��|��{��

* X X

ROBINSON MEMORIAL HOSPITAL �� {��"��=��*�@ ��X�Z��\��X�```��~�~��

��|�}��~�� }��{��

�{��`��~��*��~��~�� * X X * X X

ROSS C. DEJOHN COMMUNITY CENTER

�{�� =��*�@ ��X�Z��\�� |�}��~�� }��=��}��

��*��*��*��{��*��*�~��{��

* X X * X X * X X

SAGAMORE HILLS MEDICAL CENTER �{�� {��=��"��~�� *�@ ��XZ��\��

��|�}��~�� "��}��}��"�{�� ~��*��~��*��{��=��*��{��*��*�@��{��*�=��|~��*�=��

* X X * X X

SCHNURMANN HOUSE �{�� {��{��}�� *�@��XZ��\��

��|�}��~�� "�� *��`��~��`��}{��{��*��~��{��¤��{��*��~�{��~��{��}��~��~��*��}��}��~��~~{��*�£��{��{��*�@��{��*�@��{��}��*�|��{��£*�"��}��~�*�|��{��*��{��{��~��

* X X * X X

SENIOR FARMERS MARKET NUTRITION PROGRAM

��{�� Z��\��X```��}��~��~��{��~

��|�}��~�� `��~��"�� {��{��}��{��}�}�{��*��*��}��~��~��{��@��

* X

��


FFO

RDA

BLE

HEA

LTH

CARE

FO

R U

ND

ERIN

SURE

D/U

NIN

SURE

D

ACC

ESS

TO A

FFO

RDA

BLE

HEA

LTH

CA

RE

AN

D M

EDIC

AL

SERV

ICE

PRO

VIS

ION

Prim

ary

Care

Prev

enti

ve C

are

COM

MU

NIT

Y A

WA

REN

ESS

AN

D

COH

ESIV

ENES

S

Colla

bora

tion

Out

reac

h /

Prev

enti

on E

duca

tion

Dis

sem

inat

ion

of In

form

atio

n

INFR

AST

RUCT

URE

Tran

spor

tati

on

Nut

riti

on E

duca

tion

Aff

orda

ble

hea

lthy

food

cho

ices

Park

s an

d Re

crea

tion

Hou

sing

SHAKER HEIGHTS CITY OF - DEPARTMENT OF NEIGHBORHOOD REVITALIZATION

�{�� =��"�� *�@ ��X�Z��\��X```��~

��|�}��~�� =��}�"�� ~��}�{��¥�*��}��^��^��{�� * X X

SHAKER HEIGHTS COMMUNITY CHURCH - HUNGER NETWORK SITE

�{�� ~��"�� *�@ ��X�Z��\��X��{��

��|�}��~�� ^��{��~��~��

��{��}��Z��}��~��{��~��\��}�~��@��*��}��~{��~��

* X

SOLON DEPARTMENT OF SENIOR SERVICES

�{�� `��"��*�@ ��X�Z��\��X```��

��|�}��~�� =��"��}�"��

��*��*��*��}��`��*�~��`��*��*��{��*��{��{��`��`��*��^��{��

* * X X * X X * X X X

SOUTH POINTE HOSPITAL ��*��{��*�"{~~��*��{��

�� =�� *�@ ��XZ��\��X�```��{��

��|�}��~�� {��`��~��*��~��~��*��*��*��{��*��{��*� ��*��

* X X * X X * X X

SOUTHWEST GENERAL COMMUNITY OUTREACH WELLNESS CLINIC

�{�� @��@��{�� *�@ ��XZ��\��X�```��`��~

��|�}��~�� {�� }��~��*��`��{��*��}}��}��{��"��`��~��}��*��{��~��{��*��{��*��{��*��}��~��*��*��*��{�~��}{��*��*��^�~�*��

* * X * X

ST. VINCENT CHARITY �{�� "��*�@ ��X�Z��\��X�```��~

��|�}��~�� {��`��~��*��~��~�� * * X X * X X

SUMMIT COUNTY HEALTH DISTRICT "{~~�� ~�=��"��`*�@ ��XZ\��

��|�}��~�� }�"{~~��{��

��*��{��}��~��~��{��{��`��~��`��`��{��}��}��~��*��{��~��~��{��*��~��*��

* * X X * X X

THEA BOWMAN CENTER �{�� @��}��*�@ ��X�Z��\�� |�}��~�� =��}�� }�{��{��}�}��*��{��*��{��*��}��*��~��

* X X * X X

TRI-CITY CONSORTIUM ON AGING �{�� £��"�{��{��*�@ ��X�Z��\��X�```��

��|�}��~�� @��{��"�{��{��*��{��

��*��*��~��*��{��*�`��*��*��{�� * * X X * X X X * X X

��


FFO

RDA

BLE

HEA

LTH

CARE

FO

R U

ND

ERIN

SURE

D/U

NIN

SURE

D

ACC

ESS

TO A

FFO

RDA

BLE

HEA

LTH

CA

RE

AN

D M

EDIC

AL

SERV

ICE

PRO

VIS

ION

Prim

ary

Care

Prev

enti

ve C

are

COM

MU

NIT

Y A

WA

REN

ESS

AN

D

COH

ESIV

ENES

S

Colla

bora

tion

Out

reac

h /

Prev

enti

on E

duca

tion

Dis

sem

inat

ion

of In

form

atio

n

INFR

AST

RUCT

URE

Tran

spor

tati

on

Nut

riti

on E

duca

tion

Aff

orda

ble

hea

lthy

food

cho

ices

Park

s an

d Re

crea

tion

Hou

sing

TWINSBURG FHC "{~~�� `�=��`��{��*�@��X�Z��\�� |�}��~�� {��}��`��~��*��~��~��

* X X * X X

TWINSBURG FITNESS CENTER "{~~�� =��=��`��{��*�@ ��X�Z��\��X�```�~��`��{��~

��|�}��~�� *��^��{��~��*��*��{�� * X

TWINSBURG SENIOR CENTER "{~~�� =��=��`��{��*�@ ��X�Z��\��X�```�~��~��

��|�}��~�� "�� *��*��*��}��`��*�~��`��*��*��{��*��{��{��`��`��*��^��{��

* X X * X X * X X

UNITED WAY SENIOR INFO LINE "{~~�� "�{��"��*�"{��*�@��X�Z\��X�```��}��

��|�}��~�� }��~��}��*��{��{��{��*��`��~��}��`��~��*��

* X X

UNIVERSITY HEIGHTS COMMUNITY GARDENING

�{�� =��=�� *�@��X```�{��}��

��|�}��~�� =��}��{��{�� * X

UNIVERSITY HOSPITAL AHUJA �{�� =��~��=��`��*�@ ��X�Z��\��

��|�}��~�� {��`��~��*��~��~�� * X X * X

UNIVERSITY HOSPITAL CHAGRIN HIGHLANDS MEDICAL CENTER

�{�� @��@��£��*�@ ��XZ��\��

��|�}��~�� {��}��`��~��{��~��*��{��~�� *��*�� * X X * X X

UNIVERSITY HOSPITAL CONCORD HEALTH CARE

�{�� {�{��=��`�*�@ ��X�Z��\��

��|�}��~�� ~��}��{�� * X X * X X

UNIVERSITY HOSPITAL LANDERBROOK HEALTH CENTER

�{�� }�� *�@ ��XZ��\��

��|�}��~�� {��~��}��{��~�� * X * X X

UNIVERSITY HOSPITAL MAYFIELD VILLAGE HEALTH CENTER

�{�� "�~��=��}�� *�@ ��XZ��\��

��|�}��~�� {��~��~�� * X * X

UNIVERSITY HOSPITAL MENTOR MEDICAL CENTER

�� *�@ ��X�Z��\�� |�}��~�� {��}��`��~��*��{��*��{��~�� *��*��

* X X * X X

UNIVERSITY HOSPITAL RICHMOND �{�� =��=��~�� *�@ ��XZ��\��

��|�}��~�� {��`��~��*��~��~�� * X X * X

UNIVERSITY HOSPITAL SUBURBAN �{�� "�{��=��"�{��{��*�@ ��XZ��\��

��|�}��~�� {��~��}��{��~�� * X X * X

UNIVERSITY HOSPITAL TWINSBURG "{~~�� ~~��`��{��*�@ ��X�Z��\�� |�}��~�� {��}��`��~��*��~��{��~��*��{��~�� *��*��

* X X * X X

VILLAGE OF HIGHLAND HILLS SENIOR CITIZEN MULTI SERVICE CENTER

�{�� }��=�� *�@ ��XZ��\��

��|�}��~�� "��}��£��}� ��

��*��*��*��}��`��*�~��`��*��*��{��*��{��{��`��`��*��^��{��

* X X * X X * X X

VISITING PHYSICIANS ASSOCIATION (EAST)

��*��{��*�"{~~��*��{��

��|��{��*�@ ��X�Z\��

��|�}��~�� "�� ~��{��~��~��}��{��

* X X * X X * X

��

Organization/Provider Counties Served Contact InformationInternet Information Population Served Services Provided AFF

ORD

ABL

E H

EALT

HCA

RE F

OR

UN

DER

INSU

RED

/UN

INSU

RED

ACC

ESS

TO A

FFO

RDA

BLE

HEA

LTH

CA

RE

AN

D M

EDIC

AL

SERV

ICE

PRO

VIS

ION

Prim

ary

Care

Prev

enti

ve C

are

COM

MU

NIT

Y A

WA

REN

ESS

AN

D

COH

ESIV

ENES

S

Colla

bora

tion

Out

reac

h /

Prev

enti

on E

duca

tion

Dis

sem

inat

ion

of In

form

atio

n

INFR

AST

RUCT

URE

Tran

spor

tati

on

Nut

riti

on E

duca

tion

Aff

orda

ble

hea

lthy

food

cho

ices

Park

s an

d Re

crea

tion

Hou

sing

WESTERN RESERVE AREA AGENCY ON AGING

�{��*��{��*��*��*��

��{��"��*�@ ��XZ��\��X�```��

��|�}��~�� "�� *��*�}{��*��{��*��}��}��}��}��~��}��*��{��

* X X X * X X

WILLOUGHBY FHC ��*��{��*�"{~~��*��{��

��"@��=��{�� *�@ ��XZ��\��

��|�}��~�� {��}��`��~��{��~��*��{��~�� *��*�� * X X * X

��

��

South Pointe Hospital 20000 Harvard Road

Warrensville Heights, OH 44122

2013 Community Health Needs Assessment Implementation Strategy

As required by Internal Revenue Code § 501(r)(3)

Name and EIN of Hospital Organization Operating Hospital Facility:

Cleveland Clinic Health System-East Region # 34-0714593

Date Approved by Authorized Governing Body: September 9, 2013 Authorized Governing Body: Board of Directors, The Cleveland Clinic Foundation and ratified by the Cleveland Clinic Community Hospitals Executive Committee Contact: Cleveland Clinic [email protected]

2

TABLE OF CONTENTS I. Introduction and Purpose ........................................................................................... 3

II. Community Definition ............................................................................................... 3

III. How Implementation Strategy was Developed .......................................................... 4

IV. Goals of the Implementation Strategy ....................................................................... 4

V. Summary of the Community Health Needs Identified .............................................. 4

VI. Needs Hospital Will Address ..................................................................................... 5

VII. Needs Hospital Will Not Address .............................................................................. 6

3

2013 SOUTH POINTE HOSPITAL IMPLEMENTATION STRATEGY I. Introduction and Purpose This written plan is intended to satisfy the requirements set forth in Internal Revenue Code Section 501(r)(3) regarding community health needs assessments and implementation strategies. The overall purpose of the implementation strategy process is to align the hospital’s limited resources, program services and activities with the findings of the community health needs assessment (“CHNA”). A. Description of Hospital

South Pointe Hospital, a Cleveland Clinic hospital located in Warrensville Heights, Ohio, is a 173-bed acute care, community teaching hospital serving the healthcare needs of Cleveland's southeast suburbs. The hospital provides inpatient and outpatient services treating a variety of health conditions and specializes in cardiology, cancer, diabetes, gastroenterology, orthopaedics and pain management, primary care, radiology, urology and wound care services.

South Pointe has been designated as a Pathway to Excellence by the American Nurses Credentialing Center and is only the 2nd hospital in Ohio to achieve such designation. In addition, the hospital is the site of the Center for Osteopathic Regional Education for the Ohio University College of Osteopathic Medicine.

Cleveland Clinic defines and measures community benefit (including financial assistance) using the Catholic Health Association (“CHA”) community benefit model, which recommends reporting financial assistance on a cost basis. Using this model, in 2012 and 2011 Cleveland Clinic and its affiliates provided $754 and $693 million, respectively, in benefits to the communities they serve. The community benefit that Cleveland Clinic provides includes patient care provided on a charitable basis, research, education, Medicaid shortfall, subsidized health services and outreach programs. Cleveland Clinic’s community benefit reports are available on our website at clevelandclinic.org/communitybenefit. B. Hospital Mission South Pointe Hospital was formed in 1994 as a result of a merger between two hospitals, Brentwood Hospital and Meridia Suburban Hospital, to conduct health care, research and education activities and provide health care services persons in its community. South Pointe Hospital’s mission is:

To provide better care for the sick, investigation of their problems and education of

those who serve II. Community Definition The South Pointe Hospital community is defined as the geographic area comprising 80% of inpatient volume. The South Pointe Hospital community consists of 13 zip codes in Cuyahoga, Portage and Summit Counties: 44105, 44120, 44122, 44128, 44137, 44139, 44146, 44202, 44236, 44241, 44056, 44067 and 44087.

4

South Pointe Hospital is located within 10 miles of two other Cleveland Clinic hospitals, Hillcrest and Marymount Hospitals. Because of this proximity, a portion of South Pointe Hospital’s community overlaps with those of each of the other hospitals. These three hospitals work together as a part of the Cleveland Clinic health system to serve residents in Cleveland’s southeastern communities and suburbs. III. How Implementation Strategy was Developed This Implementation Strategy was developed by a team of members of senior leadership at South Pointe Hospital and Cleveland Clinic representing several departments of the organizations, including clinical administration, medical operations, finance and community relations. Each year, senior leadership at South Pointe Hospital and Cleveland Clinic will review this Implementation Strategy to determine whether changes should be made to better address the health needs of its communities. IV. Goals of the Implementation Strategy

A. Community Focus: Positively impact the health and wellbeing of the citizens in the communities we serve B. Value: Continually strive to increase the quality of care provided and the efficiency with which that care is delivered C. Knowledge: Actively support the efforts of researchers to discover knowledge and educators to train the next generation of health care professionals and build an engaged workforce

V. Summary of the Community Health Needs Identified Secondary data, key stakeholder interviews and focus group input were reviewed to identify and analyze the needs identified by each source. The top health needs of the South Pointe Hospital community are those that are supported both by secondary data and raised by key stakeholders and focus groups. Needs are listed by category (e.g., patient care, community services). See the South Pointe Hospital CHNA for more information: clevelandclinic.org/2013SouthPointeCHNA

A. Chronic Disease and Health Conditions

1. Heart Related Diseases 2. Adult Asthma 3. Diabetes 4. Kidney Disease 5. Low Birth Weight

B. Access to Health Services C. Research D. Education

5

E. Access to Community Services F. Economic and Community Development

VI. Needs Hospital Will Address

A. Chronic Disease and Health Conditions:

1. Heart Related Diseases South Pointe Hospital offers patient care and outreach services relating to heart diseases, including hypertension, congestive heart failure and strokes. The hospital provides inpatient and outpatient care through its Congestive Heart Failure Clinic and is designated by the Joint Commission as a Primary Stroke Center. In addition to its clinical activities, South Pointe Hospital conducts health screenings, nutrition services, and outreach activities geared toward cardiovascular health and promotion of disease management.

2. Adult Asthma

South Pointe Hospital provides acute inpatient care, outpatient care, and pulmonary rehabilitation services to patients suffering from Adult Asthma.

3. Diabetes South Pointe Hospital provides patient care and outreach activities for patients suffering from diabetes and its long-term complications. In addition, the hospital provides acute inpatient and outpatient clinical services, nutrition services, and hosts education activities and other community events on disease management. The hospital has a Diabetes Education Center with an accredited self-management program through which patients learn about meal planning, weight control, and diet modification over a three-month period.

4. Kidney Disease South Pointe Hospital provides acute inpatient and outpatient patient care services, including dialysis services and nutrition services to patients suffering from kidney disease. In 2013, the hospital opened a kidney transplant evaluation clinic in conjunction with the Cleveland Clinic main campus.

5. Low Birth Weight

South Pointe Hospital provides basic family medicine and nutrition services to patients and their children. The hospital works with Hillcrest Hospital to treat pediatric patients in need of more specialized care, including care affiliated with low birth weight babies. B. Access to Health Services South Pointe Hospital provides medically necessary services to all patients regardless of race, color, creed, gender, country of national origin or ability to pay. South Pointe Hospital has a financial assistance policy that is among the most generous in the region and covers both hospital services and physician services provided by physicians employed by the Cleveland Clinic. The financial assistance policy can be found here:

6

http://my.clevelandclinic.org/Documents/Patients/patient-financial-services-assistance.pdf South Pointe Hospital is continually working to improve its scheduling and support service model to provide consistent experience, improve metrics, and increase efficiency including providing Internet scheduling, accelerating technology implementation and scheduling training. The hospital also offers transportation services to its patients residing within a five mile radius of the hospital for their outpatient appointments. C. Research Clinical trials and other clinical research activities occur throughout the Cleveland Clinic health system including at the community hospitals.

D. Education South Pointe Hospital has an affiliation with the Ohio University College of Osteopathic Medicine and is one of the largest osteopathic teaching hospitals in Ohio. Medical students, interns and residents from across the country are trained at South Pointe. Cleveland Clinic and Ohio University plan to open a medical school extension on the South Pointe Hospital campus. The goal of the extension campus is to address the growing shortage of primary care physicians in Ohio. VII. Needs Hospital Will Not Address South Pointe Hospital cannot directly address certain community health needs identified in the CHNA. Access to Community Services and Economic and Community Development are important and may impact a person’s health status but do not relate directly to South Pointe Hospital’s mission to deliver health care. These are needs that governmental and other agencies have the more appropriate expertise and resources necessary to address. Although South Pointe Hospital cannot address these needs directly, it can and does support governmental and other agencies to help with these needs. See Appendix G for the Inventory of Available Resources of the Community Health Needs Assessment for additional detail on the organizations and programs, including those affiliated with South Pointe Hospital or the Cleveland Clinic, that are located within the South Pointe Hospital community and capable of addressing these needs. South Pointe Hospital cannot directly address the following community health needs identified in the Community Health Needs Assessment:

A. Access to Community Services This need relates to the availability and awareness of community services offered by governmental and non-profit organizations unrelated to South Pointe Hospital. Therefore, the hospital will not address this need in its implementation strategy. Although it cannot address this need, South Pointe Hospital does and will continue to collaborate with and support community organizations to help them meet this need.

7

B. Economic and Community Development The need for Economic and Community Development including the need for more housing options, parks and recreation centers, readily accessible transportation and better infrastructure, was identified as a need in the CHNA. South Pointe Hospital cannot focus or otherwise address the need for transportation, parks, or other community services unrelated to the delivery of health care. Although South Pointe Hospital is not directly involved with developing community infrastructure and improving the economy because its mission relates to the delivery of quality healthcare, it does and will continue to support local chambers of commerce and community development organizations, collaborate with leaders of regional economic improvement and provide in-kind donation of time, skill and /or sponsorships to support efforts in these areas. South Pointe Hospital employs over 1100 physicians and other caregivers and provides an overall economic benefit to the community.